Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

BackgroundPatients with end-stage renal disease undergoing haemodialysis experience a variety of stressors leading to decreased level of quality of life (QoL). Thus, in this study, we aimed to review the current literature and identify factors affecting the health-related QoL (HRQoL) in these patients.MethodsA total of 147 studies were extracted from databases of Web of Science, PubMed, Scopus, Google Scholar, and Embase published between January 2000 and December 2020. Data were analysed using R software and results were reported with reference to Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.ResultsA total of 623 728 patients undergoing dialysis participated in 147 studies in which QoL was assessed by means of two valid questionnaires, including Short-Form 36 (SF-36) and Kidney Disease Quality of Life (KDQOL)-short form V.1.3. Total HRQoL score for patients undergoing dialysis measured by KDQOL was 64.25 (95% CI 55.67 to 72.82). Based on SF-36, the mean score of mental health items was higher than the mean score of physical health condition. Furthermore, meta-regression based on the geographical place of residence revealed that the highest QoL in patients was observed in Japan, 66.96 (95% CI 63.65 to 70.28) and Brazil, 58.03 (95% CI 53.45 to 62.6).ConclusionStudies conducted on HRQoL among patients undergoing dialysis recommend useful strategies to clinicians, letting them assess patients’ QoL in terms of a wide range of physical, mental and environmental aspects.

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Reconstruction of Long Segmental Tibial Bone Defect Using the Bone Transport Compared to Acute Shortening and Re-lengthening : A Retrospective Study

10.21203/rs.3.rs-783176/v1 ◽

2021 ◽

Author(s):

Feiyu Cai ◽

Yanshi Liu ◽

Kai Liu ◽

Chenchen Fan ◽

Xiayimaierdan Maimaiti ◽

...

Keyword(s):

External Fixation ◽

Bone Defect ◽

Demographic Data ◽

Bone Transport ◽

Fixation Index ◽

Fixation Time ◽

Significant Difference ◽

Group A ◽

Group B ◽

Acute Shortening

Abstract Background: Ilizarov technique has been widely used to salvage bone defects. However, treating large bone defects remains a challenge for surgeons. The aim of this study was to compare bone transport with acute shortening/re-lengthening in a series of large tibial segmental defects.Method: A total of 39 patients (29 males, 10 females) with large tibial segmental defects were treated with the Ilizarov technique (Group A: bone transport in 23 cases; Group B: acute shortening/re-lengthening 16 in cases) from March 2010 to December 2018. The mean age was 38.7 years (range24 years to 55 years). The average bone defect size was 8.82 cm (range from 6 cm to 12 cm). The demographic data, operation duration, docking time, external fixation time, and external fixation index were retrospectively documented and analyzed. Complications that occur during the treatment were classified. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Result: There were no statistically significant differences (P>0.05) in the demographic data of the two groups. There was no significant difference in operation duration between the two groups. The docking time in group A was longer than that in group B (93.26±19.52 days, 58.44±14.23 days, P<0.001). No statistical significance was obversed for the external fixation time in the two groups (330.87±88.52 days in group A, 321.25±56.67 days in group B,P=0.704). A higher external fixation index was presented in group A (38.32±5.39 days/cm) than group B (35.17±2.14 days/cm) (P=0.033). There was no significant difference between the two groups in ASAMI bone results and functional results (Table 4). Complications were more prevalent in group A (28 complications of 23 patients), while less in group B (7 complications of 16 patients) (P<0.05).Conclusion: Both bone transport and acute shortening/re-lengthening technique can achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defect caused by infection using a monolateral rail external fixator. The acute shortening/re-lengthening can significantly decrease the docking time, external fixation index, and complications compared with bone transport.

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Presentation and management outcome of tibial infected non‑union with Ilizarov technique

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.67 ◽

2019 ◽

Vol 35 (1) ◽

Author(s):

Karim Bakhsh ◽

Atiq-Ur- Rehman ◽

Faridullah Khan Zimri ◽

Eid Mohammad ◽

Wazir Ahmed ◽

...

Keyword(s):

External Fixation ◽

Case Series ◽

Functional Results ◽

Rehabilitation Medicine ◽

Bone Transport ◽

Fixation Index ◽

Ilizarov Method ◽

Fixation Time ◽

Ilizarov Technique ◽

Non Union

Objective: To document the presentation of tibial infected non-union and analyze the management outcome with Ilizarov technique in terms of bone results, functional outcome, bone transport time, external fixation time, external fixation index and any complications. Methods: This case series was conducted at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Civil hospital, Quetta over a period of 3-years. Results: There were 56 patients with 53(94.64%) males and 3(5.35%) females. The age range was 16-50 years with a mean of 32.58±9.98years. According to ASAMI criteria, bone results were excellent in 37(66%), good in 10(17.85%), fair in 6(10.71%) and poor in 3(5.35%). The functional results were excellent in 37(66%), good in 9(16%), fair in 7(12.5%) and poor in 3(5.35%). The bone union rate was 98.21%. Conclusion: Ilizarov method beautifully addresses the formidable issue of infected non union of tibia with good outcome in terms of bone healing and infection eradication. The treatment period is relatively lengthy and hence patience on part of patient as well as the surgical team is imperative for achieving favourable outcomes. How to cite this:Bakhsh K, Atiq-Ur-Rehman, Zimri FK, Mohammad E, Ahmed W, Saaiq M. Presentation and management outcome of tibial infected non‑union with Ilizarov technique. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.67 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Double-level fixator-assisted nailing (DL-FAN)

The Bone & Joint Journal ◽

10.1302/0301-620x.101b2.bjj-2018-0622.r1 ◽

2019 ◽

Vol 101-B (2) ◽

pp. 178-188

Author(s):

M. M. Chaudhary ◽

P. H. Lakhani

Keyword(s):

External Fixation ◽

Bone Transport ◽

Fixation Index ◽

Functional Score ◽

Control Group ◽

Study Group ◽

Safe Procedure ◽

Cost Effective Treatment ◽

Custom Made ◽

The Mean

AimsDouble-level lengthening, bone transport, and bifocal compression-distraction are commonly undertaken using Ilizarov or other fixators. We performed double-level fixator-assisted nailing, mainly for the correction of deformity and lengthening in the same segment, using a straight intramedullary nail to reduce the time in a fixator.Patients and MethodsA total of 23 patients underwent this surgery, involving 27 segments (23 femora and four tibiae), over a period of ten years. The most common indication was polio in ten segments and rickets in eight; 20 nails were inserted retrograde and seven antegrade. A total of 15 lengthenings were performed in 11 femora and four tibiae, and 12 double-level corrections of deformity without lengthening were performed in the femur. The mean follow-up was 4.9 years (1.1 to 11.4). Four patients with polio had tibial lengthening with arthrodesis of the ankle. We compared the length of time in a fixator and the external fixation index (EFI) with a control group of 27 patients (27 segments) who had double-level procedures with external fixation. The groups were matched for the gain in length, age, and level of difficulty score.ResultsThe mean gain in length was statistically similar in the two groups: 3.9 cm (1.5 to 9.0) in the study group and 4.2 cm (3.4 to 5.0) in the control group (p = 0.350). The mean time in a fixator was significantly less in the study group compared with the control group: 8.6 weeks (2.0 to 22.8) versus 30.2 weeks (25.0 to 35.4; p < 0.001). The mean EFI was significantly lower in the study group compared with the control group: 17.7 days/cm (10.6 to 35.6) versus 73.4 days/cm (44.5 to 102.3; p < 0.001). The ASAMI (Association for the Study and Application of the Method of Ilizarov) bone score was excellent in 22, good in four, and fair in one. The ASAMI functional score was excellent in 20 and good in seven. There were no infections, superficial or deep.ConclusionDouble-level osteotomies or two procedures using a custom-made straight nail and external fixation can be used to correct deformities or to treat nonunion or malunion and may be combined with arthrodesis of the ankle with lengthening. It is a reasonably safe procedure that allows accurate and cost-effective treatment with a relatively short time in a fixator.

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Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

10.21203/rs.3.rs-42560/v3 ◽

2021 ◽

Author(s):

Yong-Qing Xu ◽

Xin-Yu Fan ◽

Xiao-Qing He ◽

Hong Jie Wen

Keyword(s):

Soft Tissue ◽

External Fixation ◽

Functional Results ◽

Bone Transport ◽

Fixation Index ◽

Soft Tissue Defects ◽

Safety And Efficacy ◽

Tibial Bone ◽

The Mean ◽

Tissue Defects

Abstract Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

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Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

10.21203/rs.3.rs-42560/v2 ◽

2020 ◽

Author(s):

Yong-Qing Xu ◽

Xin-Yu Fan ◽

Xiao-Qing He ◽

Hong Jie Wen

Keyword(s):

Soft Tissue ◽

External Fixation ◽

Functional Results ◽

Bone Transport ◽

Fixation Index ◽

Soft Tissue Defects ◽

Safety And Efficacy ◽

Tibial Bone ◽

The Mean ◽

Tissue Defects

Abstract Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

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Post-donation satisfaction in kidney transplantation: a survey of living donors in Japan

BMC Health Services Research ◽

10.1186/s12913-019-4556-5 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Sayaka Kobayashi ◽

Rie Akaho ◽

Kazuya Omoto ◽

Hiroki Shirakawa ◽

Tomokazu Shimizu ◽

...

Keyword(s):

Short Form ◽

Multiple Logistic Regression Analysis ◽

Japanese Version ◽

Self Report ◽

Life Orientation Test ◽

Living Kidney Donors ◽

Sf 36 ◽

Related Quality ◽

Health Related ◽

The Mean

Abstract Background No studies using a valid, standardized method to measure post-donation satisfaction levels among living kidney donors (LKDs) have been published. Methods Donor satisfaction levels were measured using the Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8), a validated, self-report questionnaire. To identify factors related to post-donation satisfaction levels, we compared donors’ sociodemographic and psychological characteristics and health-related quality of life (HRQoL), using the Short Form-36 Health Survey (SF-36), as well as recipients’ clinical characteristics and SF-36 scores between donors with and without low satisfaction. In addition, donors’ perceptions of the donation results and transplant procedure were assessed using measures that we developed. Results The mean (standard deviation [SD]) CSQ-8 score for the 195 participants was 26.9 (3.4). Twenty-nine (14.9%) respondents with total scores < 1 SD below the mean CSQ-8 score were placed into the low satisfaction group. Multiple logistic regression analysis demonstrated that lower perceptions of receiving adequate information prior to transplantation (odds ratio [OR] = 0.17; 95% confidence interval [CI] = 0.079–0.379; p < 0.001), lower optimism according to the Life Orientation Test (OR = 1.24; 95% CI = 1.045–1.470; p = 0.014), and increased serum creatinine levels in the paired recipient (OR = 0.05; 95% CI = 0.250–1.011; p = 0.054) independently increased the odds of having less satisfaction with donation. Conclusions Our findings suggest that careful pre-donation education and more detailed informed consent may be needed, especially in LKDs with low constitutional optimism.

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Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia

Journal of Clinical Medicine ◽

10.3390/jcm9020279 ◽

2020 ◽

Vol 9 (2) ◽

pp. 279

Author(s):

Irene K. Sigmund ◽

Jamie Ferguson ◽

Geertje A.M. Govaert ◽

David Stubbs ◽

Martin A. McNally

Keyword(s):

External Fixation ◽

Bone Defect ◽

Bone Transport ◽

Defect Size ◽

Fixation Index ◽

Segmental Defect ◽

Docking Site ◽

The Mean ◽

Acute Shortening

This prospective study compared bifocal acute shortening and relengthening (ASR) with bone transport (BT) in a consecutive series of complex tibial infected non-unions and osteomyelitis, for the reconstruction of segmental defects created at the surgical resection of the infection. Patients with an infected tibial segmental defect (>2 cm) were eligible for inclusion. Patients were allocated to ASR or BT, using a standardized protocol, depending on defect size, the condition of soft tissues and the state of the fibula (intact or divided). We recorded the Weber–Cech classification, previous operations, external fixation time, external fixation index (EFI), follow-up duration, time to union, ASAMI bone and functional scores and complications. A total of 47 patients (ASR: 20 patients, BT: 27 patients) with a median follow-up of 37.9 months (range 16–128) were included. In the ASR group, the mean bone defect size measured 4.0 cm, and the mean frame time was 8.8 months. In the BT group, the mean bone defect size measured 5.9cm, and the mean frame time was 10.3 months. There was no statistically significant difference in the EFI between ASR and BT (2.0 and 1.8 months/cm, respectively) (p = 0.223). A total of 3/20 patients of the ASR and 15/27 of the BT group needed further unplanned surgery during Ilizarov treatment (p = 0.006). Docking site surgery was significantly more frequent in BT; 66.7%, versus ASL; 5.0% (p < 0.0001). The infection eradication rate was 100% in both groups at final follow-up. Final ASAMI functional rating scores and bone scores were similar in both groups. Segmental resection with the Ilizarov method is effective and safe for reconstruction of infected tibial defects, allowing the eradication of infection and high union rates. However, BT demonstrated a higher rate of unplanned surgeries, especially docking site revisions. Acute shortening and relengthening does not reduce the fixator index. Both techniques deliver good functional outcome after completion of treatment.

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Reconstruction of massive tibial bone and soft-tissue defects by trifocal bone transport combined with soft-tissue transport: experience from 31 cases

10.21203/rs.3.rs-42560/v1 ◽

2020 ◽

Author(s):

Yong-Qing Xu ◽

Xin-Yu Fan ◽

Xiao-Qing He ◽

Hong Jie Wen

Keyword(s):

Soft Tissue ◽

External Fixation ◽

Functional Results ◽

Bone Transport ◽

Fixation Index ◽

Soft Tissue Coverage ◽

Soft Tissue Defects ◽

Tibial Bone ◽

The Mean ◽

Tissue Defects

Abstract Background The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion The TFT in concert with soft-tissue transport technique can be used successfully to manage large tibial bone and soft-tissue defects. Soft-tissue transport can offer a feasible method for the defects with good soft tissue coverage on the bone ends. However, imprecision in the series results precludes a definitive conclusion, and comparative study is needed to assess whether soft-tissue transport is more effective than flap transfer for such soft-tissue defect.

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Reconstruction of Long Segmental Tibial Bone Defects Caused by Infection using the Bifocal or Trifocal Bone Transport Technique with Monolateral Rail External Fixator

10.21203/rs.3.rs-506513/v1 ◽

2021 ◽

Author(s):

Alimujiang Abulaiti ◽

Yanshi Liu ◽

Feiyu Cai ◽

Kai Liu ◽

Abulaiti Abula ◽

...

Keyword(s):

External Fixation ◽

External Fixator ◽

Demographic Data ◽

Bone Defects ◽

Bone Transport ◽

Fixation Index ◽

Fixation Time ◽

Tibial Bone ◽

Operation Duration ◽

Transport Technique

Abstract Background: The purpose of this study was to evaluate the clinical effectiveness and determine the differences, if any, between trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. Methods: A total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8±12.4 years (range 19 to 65 years). 32 patients were treated by bifocal bone transport (BFT) technique, and the other 21 patients were managed by trifocal bone transport (TFT) technique. The demographic data, operation duration, docking time, external fixation time, and external fixation index were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: All patients achieved an infection-free union finally, and there was no significant difference between the two groups in demographic data and both ASAMI bone and functional scores (P>0.05). The mean defect size and operation duration in TFT (9.4±1.5 cm, 161.9±8.9 minutes) were larger than that in BFT (7.8±1.8 cm, 122.5±11.2 minutes) (P<0.05). The mean docking time, external fixation time, and external fixation index in TFT (65.9±10.8 days, 328.0±57.2 days, 34.8±2.1 days/cm) were all less than those in BFT (96.8±22.6 days, 474.5±103.2 days, 60.8±1.9 days/cm) (P<0.05). Difficulties and complications were more prevalent in the BFT group, while less in the TFT group (P<0.05). Conclusions: Both the trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator achieve satisfactory clinical outcomes. The trifocal bone transport technique can significantly decrease the docking time, external fixation time, external fixation index, difficulties, and complications compared with the bifocal bone transport technique.

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