scholarly journals Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

2019 ◽  
Author(s):  
Hongjie Wen ◽  
Shouyan Zhu ◽  
Canzhang Li ◽  
Yongqing Xu
Keyword(s):  
Bone Grafting ◽  
Meta Analysis ◽  
Functional Results ◽  
Bone Defects ◽  
Bone Transport ◽  
Bone Union ◽  
Fixation Index ◽  
Cochrane Library ◽  
Tibial Bone ◽  
Acute Shortening

Abstract Background The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the efficacy and safety between bone transport (BT) and acute shortening technique (AST) in the treatment of infected tibial bone defects.Materials and Methods A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, Embase together with China National Knowledge Infrastructure (CNKI), and Wanfang database for articles published as of August 9, 2019. NOS (Newcastle-Ottawa scale) and Cochrane's risk of bias tool were adapted to evaluated the bias and risk of each eligible study. The data of external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan V.5.3 was used to perform relevant statistical analyses. Relative risk (RR) were used for the binary variables and standard mean difference (SMD) for continuous variable. Each variable included its 95% confidence interval (CI).Results 5 studies, including a total of 199 patients, were included in the meta-analysis. Statistical significance was observed in EFI (SMD = 0.63,95% CI:0.25,1.01,P=0.001) and Bone grafting (RR = 0.26,95%CI:0.15,0.46,P<0.00001), however, no significance was observed in bone union time (SMD = -0.02, 95% CI: -0.39, 0.35, P=0.92), bone results (RR = 0.97,95%CI:0.91,1.04,P=0.41),functional results (RR = 0.96,95%CI:0.86,1.08,P=0.50) and complication (RR = 0.76,95%CI:0.41,1.39,P=0.37).Conclusions AST is preferred on the aspect of minimizing treatment period, while BT is superior to AST for reducing bone grafting. Due to the limited number of trials, The meaning of this conclusion should be taken with caution for infected tibial bone defects.

scholarly journals Bone transport versus acute shortening for the management of infected tibial bone defects: A meta-analysis

2020 ◽  
Author(s):  
Hongjie Wen ◽  
Shouyan Zhu ◽  
Canzhang Li ◽  
Yongqing Xu
Keyword(s):  
Bone Grafting ◽  
Meta Analysis ◽  
Functional Results ◽  
Bone Defects ◽  
Bone Transport ◽  
Bone Union ◽  
Fixation Index ◽  
Cochrane Library ◽  
Tibial Bone ◽  
Acute Shortening

Abstract Background: The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the efficacy and safety between bone transport (BT) and the acute shortening technique (AST) in the treatment of infected tibial bone defects.Methods: A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, and Embase databases together with the China National Knowledge Infrastructure (CNKI) and the Wanfang database for articles published up to 9 August 2019. The Newcastle-Ottawa scale (NOS) was adapted to evaluate the bias and risks in each eligible study. The data of the external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan v.5.3 was used to perform relevant statistical analyses. Relative risk (RR) was used for the binary variables and standard mean difference (SMD) for continuous variables. Each variable included its 95% confidence interval (CI).Results: Five studies, including a total of 199 patients, were included in the meta-analysis. Statistical significance was observed in the EFI (SMD = 0.63, 95% CI: 0.25, 1.01, P = 0.001) and bone grafting (RR = 0.26, 95%CI: 0.15, 0.46, P <0.00001); however, no significance was observed in bone union time (SMD = –0.02, 95% CI: –0.39, 0.35, P = 0.92), bone results (RR = 0.97, 95% CI: 0.91, 1.04, P = 0.41), functional results (RR = 0.96, 95% CI: 0.86, 1.08, P = 0.50) and complications (RR = 0.76, 95% CI: 0.41, 1.39, P = 0.37).Conclusions: AST is preferred from the aspect of minimising the treatment period, whereas BT is superior to AST for reducing bone grafting. Due to the limited number of trials, the meaning of this conclusion should be taken with caution for infected tibial bone defects.Trial registration: PROSPERO CRD42019133659

scholarly journals Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

2020 ◽  
Author(s):  
Hongjie Wen ◽  
Shouyan Zhu ◽  
Canzhang Li ◽  
Yongqing Xu
Keyword(s):  
Bone Grafting ◽  
Meta Analysis ◽  
Functional Results ◽  
Bone Defects ◽  
Bone Transport ◽  
Bone Union ◽  
Fixation Index ◽  
Cochrane Library ◽  
Tibial Bone ◽  
Acute Shortening

Abstract Background: The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the safety and efficacy between bone transport (BT) and the acute shortening technique (AST) in the treatment of infected tibial bone defects. Methods: A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, and Embase databases together with the China National Knowledge Infrastructure (CNKI) and the Wanfang database for articles published up to 9 August 2019. The modified Newcastle-Ottawa scale (NOS) was adapted to evaluate the bias and risks in each eligible study. The data of the external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan v.5.3 was used to perform relevant statistical analyses. Standard mean difference (SMD) was used for continuous variables and relative risk (RR) for the binary variables. All of the variables included its 95% confidence interval (CI). Results: Five studies, including a total of 199 patients, were included in the study. Statistical significance was observed in the EFI (SMD = 0.63, 95% CI: 0.25, 1.01, P = 0.001) and bone grafting (RR = 0.26, 95%CI: 0.15, 0.46, P <0.00001); however, no significance was observed in bone union time (SMD = –0.02, 95% CI: –0.39, 0.35, P = 0.92), bone results (RR = 0.97, 95% CI: 0.91, 1.04, P = 0.41), functional results (RR = 0.96, 95% CI: 0.86, 1.08, P = 0.50) and complications (RR = 0.76, 95% CI: 0.41, 1.39, P = 0.37). Conclusions: AST is preferred from the aspect of minimising the treatment period, whereas BT is superior to AST for reducing bone grafting. Due to the limited number of trials, the meaning of this conclusion should be taken with caution for infected tibial bone defects.

scholarly journals Efficacy of trifocal versus bifocal bone transport on large tibial bone defect: a systematic review and meta-analysis

2021 ◽  
Vol 9 (7) ◽  
pp. 2084
Author(s):  
I. Wayan Subawa ◽  
Putu Astawa ◽  
Priza Razunip ◽  
Anak A. G. D. Maha Putra ◽  
Gede M. Putra ◽  
...  
Keyword(s):  
Bone Loss ◽  
External Fixation ◽  
Bone Defect ◽  
Meta Analysis ◽  
Bone Transport ◽  
Fixation Index ◽  
Cochrane Library ◽  
Tibial Bone ◽  
Segmental Bone ◽  
Transport Technique

One of the most common long-term complication of chronic osteomyelitis of tibia is segmental bone loss. One of the methods to manage the segmental bone loss in osteomyelitis is bone transport technique, which is able to reconstruct a defect of more than 6 cm. This paper aims to systematically review and analyze the outcome of bifocal and trifocal bone distraction technique on the tibial bony defect. A comprehensive literature search was performed using PubMed, Google Scholar, and Cochrane library. The inclusion criteria were any studies about comparison between bifocal bone transports with trifocal bone transport in management of large tibial bone defect. The outcomes assessed includes external fixation index, duration of regenerate consolidation, lengthening speed, bone transport distance, and operating time. Two studies reported shorter external fixation index in total of 57 fractures in the trifocal group and 61 fractures in the bifocal group. The meta-analysis showed significant difference in external fixation index between the two groups (Figure 1; RR=-44.37; 95% CI 73.73-15.01; p<0.0001) with significant heterogeneity (Chi square=11.38, p=0.0007); I2: 91%. Although only two studies were compared, both studies had almost similar subjects, and shown that trifocal bone transport technique had faster external fixator index compared to the bifocal bone transport group in the setting of severe bone loss in tibial fracture.

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

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.

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

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.

Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects

2019 ◽  
Vol 101-B (2) ◽  
pp. 162-169 ◽  
Author(s):  
M. A. Catagni ◽  
W. Azzam ◽  
F. Guerreschi ◽  
L. Lovisetti ◽  
P. Poli ◽  
...  
Keyword(s):  
Bone Defect ◽  
Treatment Time ◽  
Operating Time ◽  
Functional Results ◽  
Bone Defects ◽  
Bone Transport ◽  
Fixation Time ◽  
Tibial Bone ◽  
Transport Distance ◽  
The Difference

Aims Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated. Patients and Methods A total of 86 consecutive patients with a long tibial bone defect (≥ 8 cm), who were treated between January 2008 and January 2015, were retrospectively reviewed. A total of 45 were treated by BFT and 41 by TFT. The median age of the 45 patients in the BFT group was 43 years (interquartile range (IQR) 23 to 54). Results The size of the bone defect was significantly longer (p = 0.005), the number of previous operations was significantly higher (p < 0.001), the operating time was significantly longer (p < 0.001), and the bone transport distance was significantly increased (p = 0.017) in the TFT group. However, the external fixation time (p < 0.001), the healing index (p < 0.001), the number of additional procedures (p = 0.013), and the number of true complications (p < 0.001) were significantly reduced in this group. Both groups achieved highly satisfactory bone and functional results. Conclusion TFT can significantly reduce the treatment time, the number of additional surgical procedures, and true complications compared with BFT in the treatment of long segmental tibial bone defects.

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

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.

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

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.

scholarly journals Bone Defects in Tibia Managed by the Bifocal Versus Trifocal Bone Transport Technique

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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