The Challenges of Monoaxial Bone Transport in Orthopedics and Traumatology

2017 ◽  
Vol 19 (4) ◽  
pp. 0-0 ◽  
Author(s):  
Michele Bisaccia ◽  
Giuseppe Rinonapoli ◽  
Luigi Meccariello ◽  
Auro Caraffa ◽  
Bartosz Cukierman ◽  
...  
Keyword(s):  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Soft Tissue Reconstruction ◽  
Non Union ◽  
Duration Of Hospitalization ◽  
Monolateral External Fixator

Background. Bone defects represent the main challenging problem for the orthopedic surgeon and, consequently, they increase the duration of hospitalization, risk of complications and health expenditures. The aim of our observational, descriptive and retrospective study is to evaluate the outcomes of patients treated with a mo­nolateral external fixator for bone defects greater than 3 cm. Material and methods. Between January 2003 and January 2013, 21 patients were treated at our center by bone transfer with a monolateral external fixator. The main etiologies were trauma in 17 cases (80.9%) and tumors in 4 cases (19.1%). Mean follow-up was 5 years for non-union and 3 years for tumors. Our clinical evaluation was based on ASAMI (Association for the Study ad Application of the Methods of Ilizarov) scores during this follow-up period. Results. The functional outcomes, based on ASAMI scores, were excellent in 12 cases, good in 7 and poor in 2. Conclusion. 1. A review of the literature related to our experience shows that bone transport is an effective tech­nique to repair loss of bone in the lower limbs. The use of a system of external fixation enables corrective actions throughout the treatment that can be in­dividualized on a case-by-case basis. In our experience, the LRS fixator (Orthofix) is a sta­ble, easy-to-use and very handy device. 2. In situations where soft tissue reconstruction procedures are needed, the size and shape of the splint should be such as not to constitute an obstacle. Fur­thermore, the use of pins rather than transfixation wires eliminates the risk of neuro / vascu­lar injury such as may occur during the application of a circular fixator. 3. The analysis of the cases presented here indicates that where possible the technique of bone transport produces good results and can often salvage the limb. Amputation should be reserved only for cases where the general and / or local preoperative status indicate that the surgeon can expect a poor result or when the compliance of the patient is determined to be inadequate.

scholarly journals Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Jialin Liu ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Segmental Bone Transport ◽  
The Mean ◽  
Forearm Bone ◽  
Segmental Bone ◽  
Transport Technique

Abstract Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

scholarly journals Efficacy Comparison of Trifocal Bone Transport Using Unilateral External Fixator for Femoral and Tibial Bone Defects Caused by Infection

2021 ◽  
Author(s):  
Kai Liu ◽  
Yanshi Liu ◽  
Feiyu Cai ◽  
Chenchen Fan ◽  
Peng Ren ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Bone Defects ◽  
Bone Transport ◽  
Limb Bone ◽  
The Mean ◽  
Fair Poor

Abstract Background: This study aimed to evaluate the clinical and functional outcomes of patients with critical femoral and tibial bone defects treated by trifocal bone transport using the Ilizarov method.Methods: In a retrospective comparative study, 39 patients treated for lower limb bone non-union with bone loss measuring between 6 and 14 cm were included. Depending on the location of bone transport, the patients were divided into the femur group (n =18) and tibia groups (n =21). The demographics data, intraoperative records, and postoperative outcomes were documented and compared between the two groups. At the last follow-up, the bone and functional outcomes were evaluated according to the criterion given by the Association for the Study and Application of the Method of the Ilizarov (ASAMI) and postoperative complications evaluated by Paley classification.Results: The average follow-up time was 26.1 months (range 17–34 months) since the unilateral external fixators were removed. The mean size of the bone defect was 8.3 cm in the femur group, and 7.5 cm in the tibia group. All bone defects were reconstructed successfully. The mean time in external fixation in the femur group was 334.4 days, and in the tibia group was 344.6 days. The external fixation index (EFI) measured 55.9 days/cm in the femur group and 65 days/cm in the tibia group. A statistically significant difference of bone grade was found between the two groups (excellent/good/fair/poor, 3/11/3/1 vs 2/13/4/2, P<0.05), as well as the function grade in two groups (excellent/good/fair/poor/failure, 3/14/1/0 vs 4/13/3/1, P<0.05). According to the ASAMI classification, the clinical and functional results in the femur group were better than in the tibia group. The complication rate of the two groups was 94.4% vs 76.2% (femur vs tibia). One femur and five tibias were performed additional surgery because of delayed union and axial deviation. Conclusions: The trifocal bone transport using the unilateral external fixator is a reliable treatment in the management of post-traumatic and post-infection lower limb bone defects (>6cm). In the comparison of the tibia, the trifocal bone transport treatment period of the femur was shorter, the functional recovery was better and the risk of minor complications was higher.

scholarly journals Treatment of Diaphyseal Forearm Defects Caused by Infection Using Ilizarov Segmental Bone Transport Technique

2020 ◽  
Author(s):  
Yanshi Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Jialin Liu ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Segmental Bone Transport ◽  
The Mean ◽  
Forearm Bone ◽  
Segmental Bone ◽  
Transport Technique

Abstract Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection.Methods: This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23-57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up.Results: There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p<0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusion: Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

Bone transport osteogenesis for treatment of canine osteomyelitis

2010 ◽  
Vol 23 (02) ◽  
pp. 134-140 ◽  
Author(s):  
S. W. Petersen ◽  
L. M. Déjardin ◽  
D. Ting
Keyword(s):  
Bone Defects ◽  
Bone Transport ◽  
Infected Nonunion ◽  
Non Union ◽  
Post Surgery ◽  
Bone Segment ◽  
Extensive Debridement ◽  
Segmental Bone ◽  
Osseous Defects

SummaryBone transport osteogenesis, as described by Ilizarov, has been used to resolve segmental bone defects in both human and veterinary patients. These defects are created when a large osseous tumour, sequestrum, or non-union fracture is resected. This report documents two cases in which the principle of bone transport osteogenesis was applied by utilising the Ilizarov technique to bridge large osseous defects resulting from debridement of an infected nonunion fracture (case 1) and debridement of a sequestrum (case 2). Defects were treated by transporting either a complete or a hemi-circumferential bone segment. Both cases had resolution of osteomyelitis, satisfactory fracture union, and functional usage of the limb 39 weeks and 15 weeks post-surgery, respectively. Although manageable complications were encountered during the treatment of these cases, the long-term clinical outcome was eventually favorable. The authors believe that bone transport osteogenesis offers a valid restorative option in the treatment of bone defects resulting from extensive debridement and sequestrectomy.

Metacarpal and Phalangeal Lengthening by Callus Distraction

2001 ◽  
Vol 26 (1) ◽  
pp. 13-16 ◽  
Author(s):  
S. HOUSHIAN ◽  
T. IPSEN
Keyword(s):  
External Fixator ◽  
Callus Distraction ◽  
Functional Improvement ◽  
Traumatic Amputation ◽  
Non Union ◽  
Bone Length ◽  
Epiphyseal Closure

Twelve metacarpals and two phalanges in 14 patients (nine males and five females) were lengthened between August 1992 and March 1999 by the callus distraction technique using a small external fixator (Orthofix®). The indications were traumatic amputation (10 cases), aplasia (three cases) and hypoplasia owing to premature epiphyseal closure of the metacarpal (one case). All patients were reviewed with a median follow-up time of 39 (range, 9–88) months. The median age of the patients was 15 (range, 4–39) years. The median lengthening was 21 (range, 13–34) mm which was a median of 82% (range, 38–162) of the original bone length. The median times for callus distraction and consolidation were 4.5 and 7.5 weeks respectively. All except one patient tolerated the procedure well and were satisfied with the results. Functional improvement was seen in 13 out of 14 patients, but non-union was observed in one patient.

scholarly journals Complications Associated with Bifocal Bone Transport Using Unilateral External Rail Fixator in the Reconstruction of Femur Defects Caused by Infection: Outcome Analysis of 76 Patients

2021 ◽  
Author(s):  
Cong Peng ◽  
Kai Liu ◽  
Qi Tian ◽  
Maimaitiaili Tusunniyazi ◽  
Weiqi Kong ◽  
...  
Keyword(s):  
External Fixator ◽  
Joint Stiffness ◽  
Bone Defects ◽  
Bone Transport ◽  
Delayed Union ◽  
Outcome Analysis ◽  
Femoral Bone ◽  
Single Level ◽  
Radical Debridement ◽  
Pin Tract Infection

Abstract Background: The purpose of this study is to evaluate the outcomes of single-level bone transport in the treatment of femoral bone defects after radical debridement, which were caused by infections.Methods: Clinical and radiographic data of patients with infected femoral nonunion treated with a unilateral external fixator (Orthofix limb reconstruction system, LRS) at our hospital from 2010 to 2019 were analyzed retrospectively. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes and postoperative complications evaluated by Paley classification. Results: Seventy-six cases of infected femoral bone defects (31 proximal, 19 intermediate, and 26 distal) were managed by single-level bone transport using a unilateral external fixator with a mean follow-up time of 30.8 (23 to 41) months. There were 58 men (76.3%) and 18 women (23.6%), with a mean age of 38.8 years (range, 23 – 60 years). The bone union was achieved in 76 cases with a mean time of 6.9 months (range, 5-8 months). Complications included 29 cases (38.1%) of pin tract infection, 7 cases (9.2%) of muscle contractures, 3 cases (7.9%) of joint stiffness, 13 cases (17.1%) of axial deviation, 2 cases (2.6%) of delayed union, one case (1.3%) of nonunion, and none (0%) of transport gap re-fracture. One patient (1.3%) was scheduled for knee arthroplasty when bone transport treatment ended.Conclusions: Bone transport in the reconstruction of femoral bone defects using unilateral external rail fixator had a satisfactory rate of bone healing and limb function recovery. Complications of distal femoral bone transport were more severe than other sites, but the complication rate was the least of the three. Complications of the proximal were comparable to the intermediate, and soft-tissue-related complications were more likely to occur in the intermediate transport.

scholarly journals Risk factors associated with transport gap bending deformity after bone transport in the treatment of lower extremity bone defects caused by infection

2021 ◽  
Author(s):  
Kai Liu ◽  
Yanshi Liu ◽  
Feiyu Cai ◽  
Chenchen Fan ◽  
Alimujiang Abulaiti ◽  
...  
Keyword(s):  
Risk Factors ◽  
External Fixator ◽  
Lower Limb ◽  
Lower Extremities ◽  
Bone Defects ◽  
Bone Transport ◽  
Bone Infection ◽  
Limb Bone ◽  
Factors Associated ◽  
Independent Risk Factors

Abstract Background: The objective of this study was to observe the efficacy of bone transport using Orthofix external fixator in the treatment of lower limb bone defects caused by infection, and analyze the mechanism and risk factors of transport gap bending deformity (TGBD).Methods: From January 2008 to December 2019, 326 cases of infected bone defects of the lower extremities were treated by bone transport in our medical institution. The location and other relevant information of TGBD were collected, summarized, and analyzed. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. Results: A total of 326 patients have reconstructed the bone defects in the lower extremities successfully, with a mean size of 6.2 centimeters (3.4 - 9.1 cm). TGBD was observed in 42 patients (12.8%) after removing the external fixator, including 32 tibias and 10 femurs, after a mean follow-up of 28.6 months (22 – 47 months). Age>45years, BMI>25kg/m2, defect of the tibia, diabetes, osteoporosis, glucocorticoid intake, duration of bone infection>24months, EFT>9months, EFI>1.8months/cm were associated significantly with a higher incidence of TGBD in the binary logistic regression analysis. The independent risk factors associated with TGBD included age>45 years, BMI>25 kg/m2, defect of tibia, diabetes, osteoporosis. Conclusions: The bone transport using the Orthofix external fixator is a safe and practical method in the treatment of lower limb bone defects caused by infection. The incidence of TGBD was 12.8%, and the top five risk factors included defect of tibia, BMI>25kg/m2, duration of bone infection>24 months, age>45years, and diabetes. Age>45years, BMI>25kg/m2, defect of tibia, osteoporosis, diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.

scholarly journals Acute correction of proximal tibial coronal plane deformity in small children using a small monolateral external fixator with or without cross-pinning

2021 ◽  
pp. 1-6
Author(s):  
Chaemoon Lim ◽  
Chang Ho Shin ◽  
Won Joon Yoo ◽  
Tae-Joon Cho
Keyword(s):  
External Fixator ◽  
Proximal Tibia ◽  
Weight Bearing ◽  
Coronal Plane ◽  
Time Interval ◽  
Angular Deformity ◽  
Small Children ◽  
Monolateral External Fixator ◽  
Tibia Osteotomy

PurposeSurgical correction of proximal tibia deformity in small children can be challenging. We present the surgical technique and outcome of proximal tibia osteotomy fixed with small monolateral external fixator in this patient group.MethodsA total of 17 cases in eight patients younger than nine years of age were study subjects. A proximal tibia osteotomy was fixed with a small monolateral external fixator with or without cross-pinning. Outcome was evaluated by changes of radiographic parameters such as medial proximal tibia angle (MPTA), metaphyseal diaphyseal angle (MDA) and clinical findings of complications, time interval until weight bearing and fixator removal time.ResultsMPTA improved from a preoperative mean of 73° (sd 4°; 66° to 78°) to an immediate postoperative mean of 90° (sd 3°; 85° to 96°) in varus tibiae, and from 104° (sd 1°; 103° to 105°) to 89° (sd 1°; 88° to 89°) in valgus tibiae. In all, 15 of the 17 cases (88.3 %) achieved postoperative MPTA within the normal range (85° to 90°). MDA improved from a preoperative mean of 19° (sd 5°; 11° to 24°) to an immediate postoperative mean of 0° (sd 4°; -6° to 7°) in varus tibiae, and from -25° (sd 2°; -22° to -24°) to 2° (SD 1°; 1° to 3°) in valgus tibiae. Full weight bearing was possible at mean 1.7 months (0.5 to 3.0). Mean follow-up period was 6.5 years (sd 5.4; 1.0 to 16.0). No complications developed during the follow-up.ConclusionProximal tibia osteotomy fixed with small monolateral external fixator provides accurate, safe and efficient correction in the management of coronal plane angular deformity in small children.Level of EvidenceLevel IV

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