Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2020; 11(6): 304-318
Published online Jun 18, 2020. doi: 10.5312/wjo.v11.i6.304
Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved
Dmitry Y Borzunov, Sergei N Kolchin, Tatiana A Malkova
Dmitry Y Borzunov, Department of Traumatology and Orthopedics, Ural State Medical University, Ekaterinburg 620109, Russia
Sergei N Kolchin, Orthopaedic Department 4, Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan 640014, Russia
Tatiana A Malkova, Department for Medical Information and Analysis, Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan 640014, Russia
Author contributions: Malkova TA and Kolchin SN contributed to the acquisition of data; all authors contributed to the conception and design, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dmitry Y Borzunov, MD, PhD, Doctor, Professor, Research Scientist, Surgeon, Department of Traumatology and Orthopedics, Ural State Medical University, No. 3, Repina Street, Ekaterinburg 620109, Russia. borzunov@bk.ru
Received: February 26, 2020
Peer-review started: February 26, 2020
First decision: April 25, 2020
Revised: May 6, 2020
Accepted: May 16, 2020
Article in press: May 16, 2020
Published online: June 18, 2020
Abstract
BACKGROUND

Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.

AIM

To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.

METHODS

Three databases (PubMed, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period (2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results, complications and described large patient samples (not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.

RESULTS

Fifty full-text articles and reviews on distraction osteogenesis were chosen. Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously (bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.

CONCLUSION

The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.

Keywords: Bone defect, Ilizarov method, Distraction osteogenesis, Bone transport, Bone nonunion, Free vascularized grafts, Induced membrane technique complication

Core tip: The Ilizarov non-free bone plasty can treat the triad of problems associated with bone defects simultaneously (bone loss, soft tissue loss and infection) without the need for major plastic surgery. It provides a stable mechanical environment, corrects deformities, and enables weight bearing. The findings suggest that the Ilizarov fixator is better suited for infected nonunion of the tibia, while monolateral fixators are valid for the femur. High rates of successful treatment were reported and depended on the pathology and type of the Ilizarov method protocols used. Docking site nonunion and after-frame regenerate fracture or deformity are the major causes of failure.