Clinical outcomes of bone transport using rail fixator in the treatment of femoral nonunion or bone defect caused by infection

Purpose The rail fixator can improve the treatment outcome and provide good stability in patients with femoral bone transport. The purpose of this study is to investigate the clinical outcomes of bone transport using the Ilizarov technique by rail fixator in the treatment of femoral nonunion or bone defects caused by infection. Methods Clinical feature and treatment outcomes of 32 consecutive adult patients with femoral nonunion or bone defect caused by infection from January 2012 to January 2019 at a minimum of 2 years of follow-ups were retrospectively analyzed. Data were collected on participants' demographic details. All difficulties related to bone transport were documented according to Paley's classification. The clinical outcomes were evaluated using ASAMI criteria at the last clinical visit. Results All 32 patients with an average follow-up of 33.5 months. There were 17 problems, 21 obstacles, and 8 complications, and the complication rate per patient was 1.4. The main complications were pin-site infection (53.1%), axial deviation (21.9%), joint stiffness (18.8%), the delayed union of the docking site (18.8%), soft tissue incarceration(15.6%), delayed consolidation(6.3%), malunion(6.3%), and refracture (3.1%). All the patients achieved bone union, and no recurrence of infection was observed. The excellent and good rates of ASAMI bone and functional results were 87.5% and 81.3%, respectively. Conclusion Bone transport using the Ilizarov technique is an effective method for the treatment of femoral nonunion or bone defect caused by infection, and rail fixators have obtained satisfactory results in terms of bone and functional results.

[1]  A. Yusufu,et al.  Tetrafocal (three osteotomies) and pentafocal (four osteotomies) bone transport using Ilizarov technique in the treatment of distal tibial defect-preliminary outcomes of 12 cases and a description of the surgical technique. , 2022, Injury.

[2]  Y. Tu,et al.  Ipsilateral vascularised fibula with external locking plate for treatment of massive tibial bone defects. , 2021, Injury.

[3]  L. Yin,et al.  A Systematic Review and Meta-Analysis of Combined Antibiotic Spacer with Ilizarov Methods in the Treatment of Infected Nonunion of Tibia , 2021, BioMed research international.

[4]  C. Iacobellis,et al.  Functional outcome and complications after treatment of comminuted tibial fractures or deformities using Ilizarov bone transport: a single-center study at 15- to 30-year follow-up , 2020, Archives of Orthopaedic and Trauma Surgery.

[5]  Chuang Ma,et al.  Bifocal or Trifocal (Double‐Level) Bone Transport Using Unilateral Rail System in the Treatment of Large Tibial Defects Caused by Infection: A Retrospective Study , 2020, Orthopaedic surgery.

[6]  Hany El zahlawy,et al.  Bifocal Compression-Distraction for combined Bone and Soft Tissue Defects in Post-traumatic Tibial Nonunion. , 2019, Journal of orthopaedic trauma.

[7]  C. Şen,et al.  Acute shortening versus bone transport for the treatment of infected femur non-unions with bone defects. , 2019, Injury.

[8]  M. Saaiq,et al.  Outcome of complex non-unions of femoral fractures managed with Ilizarov method of distraction osteogenesis , 2019, Pakistan journal of medical sciences.

[9]  K. Aktuglu,et al.  Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review , 2019, Journal of Orthopaedics and Traumatology.

[10]  P. Han,et al.  L-shaped corticotomy with bone flap sliding in the management of chronic tibial osteomyelitis: surgical technique and clinical results , 2019, Journal of Orthopaedic Surgery and Research.

[11]  R. Kapila,et al.  Comparision of Ilizarov Ring Fixator and Rail Fixator in Infected Nonunion of Long Bones: A Retrospective Followup Study , 2019, Indian journal of orthopaedics.

[12]  M. Saaiq,et al.  Presentation and management outcome of tibial infected non-union with Ilizarov technique , 2019, Pakistan journal of medical sciences.

[13]  N. Aydogan,et al.  Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. , 2018, Injury.

[14]  P. Tang,et al.  Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation , 2017, Journal of Orthopaedic Surgery and Research.

[15]  Zhong Li,et al.  Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia , 2017, Medicine.

[16]  G. Wang,et al.  Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. , 2017, Injury.

[17]  M. Hossain,et al.  Induced membrane technique for treating tibial defects gives mixed results , 2017, The bone & joint journal.

[18]  W. Khan,et al.  Limb reconstruction after traumatic bone loss. , 2017, Injury.

[19]  P. Giannoudis,et al.  Masquelet technique for the treatment of segmental bone loss have we made any progress? , 2016, Injury.

[20]  R. Rohilla,et al.  Prospective randomised comparison of ring versus rail fixator in infected gap nonunion of tibia treated with distraction osteogenesis. , 2016, The bone & joint journal.

[21]  Sang Bum Kim,et al.  Plate augmentation and autologous bone grafting after intramedullary nailing for challenging femoral bone defects: a technical note , 2016, Archives of Orthopaedic and Trauma Surgery.

[22]  I. L. Smirnova,et al.  Contribution of G.A. Ilizarov to bone reconstruction: historical achievements and state of the art , 2016, Strategies in Trauma and Limb Reconstruction.

[23]  Chao Lu,et al.  Retrospective study , 2016, Medicine.

[24]  Srinath Gupta,et al.  Definitive Management of Open Tibia Fractures Using Limb Reconstruction System. , 2016, Journal of clinical and diagnostic research : JCDR.

[25]  V. Mittal,et al.  Comparative study of the results of compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators. , 2015, Chinese journal of traumatology = Zhonghua chuang shang za zhi.

[26]  Z. Mao,et al.  A Systematic Review and Meta-Analysis of Ilizarov Methods in the Treatment of Infected Nonunion of Tibia and Femur , 2015, PloS one.

[27]  P. Giannoudis,et al.  Surgical management of infected non-unions: An update. , 2015, Injury.

[28]  H. Ullah,et al.  Outcome of ilizarov fixator in complex non-union of long bones. , 2015, JPMA. The Journal of the Pakistan Medical Association.

[29]  I. Villemure,et al.  The Accordion Maneuver: A Noninvasive Strategy for Absent or Delayed Callus Formation in Cases of Limb Lengthening , 2015, Advances in orthopedics.

[30]  G. Hosny,et al.  Management of infected nonunion of the femur in adults using the Ilizarov technique , 2014 .

[31]  Divesh Jalan,et al.  Management of nonunion of lower-extremity long bones using mono-lateral external fixator--report of 37 cases. , 2014, Injury.

[32]  M. Bhandari,et al.  Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. , 2013, The bone & joint journal.

[33]  Y. M. Khira,et al.  Pedicled vascularized fibular graft with Ilizarov external fixator for reconstructing a large bone defect of the tibia after tumor resection , 2013, Journal of Orthopaedics and Traumatology.

[34]  Zhihong Li,et al.  Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study , 2013, European Journal of Orthopaedic Surgery & Traumatology.

[35]  P. Marik,et al.  Narrative Review , 2012, Journal of intensive care medicine.

[36]  Vikas Gupta,et al.  Distraction Osteogenesis Using a Monolateral External Fixator for Infected Non-Union of the Femur with Bone Loss , 2012, Journal of orthopaedic surgery.

[37]  D. Borzunov.  Long bone reconstruction using multilevel lengthening of bone defect fragments , 2012, International Orthopaedics.

[38]  Alessandro Bistolfi,et al.  Antibiotic-Loaded Cement in Orthopedic Surgery: A Review , 2011, ISRN orthopedics.

[39]  K. Malizos,et al.  Vascularized fibula transfer for lower limb reconstruction , 2011, Microsurgery.

[40]  S. Morgan,et al.  Complications associated with distraction osteogenesis for infected nonunion of the femoral shaft in the presence of a bone defect: a retrospective series. , 2010, The Journal of bone and joint surgery. British volume.

[41]  C. Iacobellis,et al.  Bone transport using the Ilizarov method: a review of complications in 100 consecutive cases , 2010, Strategies in trauma and limb reconstruction.

[42]  N. S. Motsitsi.  Management of infected nonunion of long bones: the last decade (1996-2006). , 2008, Injury.

[43]  Andrzej Galat,et al.  Technical note , 2008, Comput. Biol. Chem..

[44]  A. Krishnan,et al.  Modified Ilizarov Technique for Infected Nonunion of the Femur: The Principle of Distraction-Compression Osteogenesis , 2006, Journal of orthopaedic surgery.

[45]  E. Panagiotopoulos,et al.  The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. , 2006, The Journal of bone and joint surgery. British volume.

[46]  Edward Abraham,et al.  Bone transport in the management of posttraumatic bone defects in the lower extremity. , 2004, The Journal of trauma.

[47]  A. Gösele,et al.  The value of intramedullary reaming in the treatment of chronic osteomyelitis of long bones , 2004, Archives of Orthopaedic and Trauma Surgery.

[48]  J. Mader,et al.  A Clinical Staging System for Adult Osteomyelitis , 2003, Clinical orthopaedics and related research.

[49]  B. Daviss.  Vaginal delivery after caesarean section , 2001, BMJ : British Medical Journal.

[50]  N. Vučić,et al.  Treatment of osteomyelitis and infected non-union of the femur by a modified Ilizarov technique: follow-up study. , 2001, Croatian medical journal.

[51]  D. Paley,et al.  Ilizarov bone transport treatment for tibial defects. , 2000, Journal of orthopaedic trauma.

[52]  Robert C. Wolpert,et al.  A Review of the , 1985 .

[53]  K. Johnson.  An Update. , 1984, Journal of food protection.

[54]  C. Paúl,et al.  Education, leisure activities and cognitive and functional ability of Alzheimer's disease patients: A follow-up study , 2013, Dementia & neuropsychologia.