Antibiotic calcium sulfate-loaded hybrid transport versus traditional Ilizarov bone transport in the treatment of large tibial defects after trauma

Background The purpose of this study was to compare the clinical effects of antibiotic calcium sulfate-loaded hybrid transport (ACSLHT) and traditional Ilizarov bone transport (TIBT) in the treatment of large tibial defects after trauma. Methods Eighty-five patients with large tibial defects after trauma were selected for retrospective study. The range of tibial defects was 6–22 cm. After thorough debridement and infection controlled, bone transport technique was used to reconstruct tibial defects. Forty-four patients were treated with ACSLHT technique (the ACSLHT group), while the other 41 were treated with TIBT technique (the TIBT group). Time in external fixator was evaluated by EFI score. Enneking score was used to evaluate limb functions. SAS score was used to evaluate postoperative anxiety status. In addition, complication incidence was compared, including axis deviation, docking site nonunion, infection recurrence and so on. Results There was no significant difference in preoperative general data between ACSLHT and TIBT group. EFI score in ACSLHT and TIBT group was 0.6 ± 0.1 cm/month and 1.7 ± 0.3 cm/month, respectively (P < 0.05). Enneking score of ACSLHT and TIBT group was 86.5% and 75.1% (P < 0.05). SAS score of ACSLHT group was significantly lower than that of TIBT group (P < 0.05). Complication incidence in ACSLHT group was significantly lower than that in TIBT group (P < 0.05). Conclusions Compared with TIBT group, ACSLHT group had shorter time in external fixator, better limb functions, lower postoperative anxiety score and lower complication incidence which is worth of clinical promotion.

Risk factors associated with infection recurrence of posttraumatic osteomyelitis treated with Ilizarov bone transport technique—a retrospective study of 149 cases

Background Post-traumatic tibial osteomyelitis is considered as complex clinical problem due to its unique characteristics such as prolonged course, multi-staged treatment and high recurrence rate. The purpose of this study is to identify and analyze the causes and risk factors associated with infection recurrence of tibial osteomyelitis treated with Ilizarov technique. Methods From January 2011 to January 2019, a total of 149 patients with post-traumatic tibial osteomyelitis treated with Ilizarov bone transport technique were included in this study. Demographic and clinical data were collected and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the recurrence or reinfection of post-traumatic tibial osteomyelitis after treated with Ilizarov bone transport technique. Results All included patients were successfully followed up with an average of 37.5 month (18–78 month), among them, 17 patients (11.4%) occurred with recurrence or reinfection of tibial osteomyelitis in which 2 cases were in distraction area and 15 cases in docking site. Among them, 5 patients were treated successfully with appropriate intravenous antibiotic, the remaining 12 patients were intervened by surgical debridement or bone grafting after debridement. Univariate analysis showed that Pseudomonas aeruginosa infection, bone exposure, number of previous operations (> 3 times), blood transfusion during bone transport surgery, course of osteomyelitis > 3 months, diabetes was associated with recurrence or reinfection of postoperative tibial osteomyelitis. According to the results of logistic regression analysis, Pseudomonas aeruginosa infection, bone exposure, and the number of previous operations (> 3 times) are risk factors for recurrence or reinfection of posttraumatic tibial osteomyelitis treated with Ilizarov bone transport technique, with odds ratios (OR) of 6.055, 7.413, and 1.753, respectively. Conclusion The number of previous operations (> 3 times), bone exposure, and Pseudomonas aeruginosa infection are risk factors for infection recurrence of posttraumatic tibial osteomyelitis treated with Ilizarov bone transport technique.

A Rare Case of Ewing’s-like Adamantinoma of Tibia Managed by Limb Salvage Surgery Using Long Segment Ilizarov Bone Transport: A Case Report and Review of Literature

Introduction: Adamantinoma is a rare low-grade malignant tumor in young adults. Recent advances in molecular techniques have shown different variants with discordance between genotype and phenotype. This poses a challenge in diagnosis and management. Ewing’s-like adamantinoma is one such variant. The appropriate treatment protocol for this dedifferentiated tumor remains to be established. Here, we present a rare case of Ewing’s-like Adamantinoma treated with limb salvage surgery using three step Ilizarov technique with good results. Case Report: A 38-year-old lady presented at our OPD complaining of recent onset pain and gradual increase in size over a long standing swelling in the right lower tibia. Radiologically was diagnosed as Ewing’s but was not responsive to chemotherapy. A Tru-Cut biopsy showed histological picture of dedifferentiated adamantinoma. Immunohistochemistry showed CD99 positivity. FISH revealed (11;22) translocation confirming Ewing’s-like adamantinoma. She was managed with wide excision followed by staged Ilizarov distraction-osteogenesis and bone transport to correct the 13 cm discrepancy in bone length. There have been no signs of recurrence on post-resection follow-up of 2 years. Patient attained full range of knee and ankle movements. Conclusion: The controversy as to what constitutes the difference between adamantinoma-like Ewing’s and Ewing’s-like adamantinoma persists despite technological advances. The appropriate treatment protocol remains to be established. Ilizarov three step techniques provide a feasible alternative to amputation while circumventing the difficulties of large bone reconstruction in the distal tibia. Keywords: Adamantinoma, Ewing’s-like, Ilizarov, bone transport, dedifferentiated, malignant bone tumor.

Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects

Objective To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects. Methods We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities. Results All infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients’ wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients. Conclusion Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.

Ilizarov bone transport to treat infected nonunion of long bones: a multicenter retrospective cohort study

Objective To examine the efficacy and safety of Ilizarov bone transport in the treatment of infected nonunion of long bones. Methods Patients who underwent Ilizarov bone transport for treatment of bone nonunion with chronic osteomyelitis in the three largest regional orthopedic trauma centers in China from July 2013 to July 2018 were retrospectively examined. Treatment results were evaluated with Paley’s criteria for bone healing and functional assessment. Results In total, 189 patients were treated during the study period. The study population comprised 135 male and 54 female patients with an average age of 37.5 years (range, 11–61 years). The patients were followed up for at least 24 months. According to Paley’s criteria for bone healing and functional assessment, the bone healing results were excellent in 115 (61%) patients, good in 31 (16%), fair in 21 (11%), and poor in 22 (12%). The functional evaluation results were excellent in 76 (40%) patients, good in 65 (34%), fair in 22 (11%), poor in 26 (14%). Conclusion Infected nonunion of long bones can be effectively and safely treated with Ilizarov bone transport.

Risk Factors Associated with Infection Recurrence of Posttraumatic Osteomyelitis Treated with Ilizarov Bone Transport Technique—A Retrospective Study of 149 Cases

Background: Post-traumatic tibial osteomyelitis is considered as complex clinical problem due to its unique characteristics such as prolonged course, multi-staged treatment and high recurrence rate. The purpose of this study is to identify and analyze the causes and risk factors associated with infection recurrence of tibial osteomyelitis treated with Ilizarov technique. Methods: From January 2011 to January 2019, a total of 149 patients with post-traumatic tibial osteomyelitis treated with Ilizarov bone transport technique were included in this study. Demographic and clinical data were collected and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the recurrence or reinfection of post-traumatic tibial osteomyelitis after treated with Ilizarov bone transport technique.Results: All included patients were successfully followed up with an average of 37.5 month (18-78 month), among them, 17 patients (11.41%) occurred with recurrence or reinfection of tibial osteomyelitis in which 2 cases were in distraction area and 15 cases in docking site. Among them, 5 patients were treated successfully with sensitive intravenous antibiotic, the remaining 12 patients were intervened by surgical debridement or bone grafting after debridement. Univariate analysis showed that pseudomonas aeruginosa infection, bone exposure, number of previous operations (>3 times), blood transfusion during bone transport surgery, course of osteomyelitis >3 months, diabetes was associated with recurrence or reinfection of postoperative tibial osteomyelitis. According to the results of logistic regression analysis, pseudomonas aeruginosa infection, bone exposure, and the number of previous operations (>3 times) are risk factors for recurrence or reinfection of posttraumatic tibial osteomyelitis treated with Ilizarove bone transport technique, with odds ratios (OR) of 6.055, 7.413, and 1.753, respectively. Conclusion: The number of previous operations (>3 times), bone exposure, and pseudomonas aeruginosa infection are risk factors for infection recurrence of posttraumatic tibial osteomyelitis treated with Ilizarove bone transport technique.

Retraction of transporting bone segment during Ilizarov bone transport

Background Retraction of transporting bone segment (TBS) may occur when the fixator of the TBS is removed prior to full consolidation of the distracted callus, which has adverse effect on the healing of the docking site. However, there are few reports on the retraction of TBS. The purpose of this study is to analyze the causes and risk factors of the retraction of TBS. Methods The clinical data of 37 cases with tibial bone defect treated by Ilizarov bone transport were analyzed retrospectively, in whom the TBS fixator was removed prior to full consolidation of the distracted callus and union of the docking site. Bivariate correlation was used to analyze relationship between the retraction distance of TBS and potential risk factors including age, gender, course, length of bone defect, number of operations, size of TBS, transport distance, timing and time interval of removal of TBS fixator. Risk factors with significant level were further identified using multivariate linear regression. Results Bivariate correlation showed that the timing of removal was negatively correlated with the retraction distance, and the time interval and transport distance were positively correlated with the retraction distance(p < 0.05), the age, gender, course, length of bone defect, size of TBS and number of operations were not correlated with the retraction distance(p > 0.05). Multivariate linear regression of the 3 risk factors showed that the timing of removal and time interval were the main risk factors affecting the retraction distance (p < 0.05), but the transport distance was not (p > 0.05). Conclusion The traction forces of TBS endured from the soft tissues and the unconsolidated distracted callus have elastic properties, which can make retraction of TBS. The timing of removal and time interval are the main risk factors of the retraction of TBS. In the case of early removal, another external fixation or quickly converted to internal fixation should be performed to avoid the adverse effect of more retraction.

Retraction of transporting bone segment during Ilizarov bone transport

Background: Retraction of transporting bone segment (TBS) may occur when the fixator of the TBS is removed prior to full consolidation of the distracted callus, which has adverse effect on the healing of the docking site. However, there are few reports on the retraction of TBS. The purpose of this study is to analyze the causes and risk factors of the retraction of TBS. Methods: The clinical data of 37 cases with tibial bone defect treated by Ilizarov bone transport were analyzed retrospectively, in whom the TBS fixator was removed prior to full consolidation of the distracted callus and union of the docking site. Bivariate correlation was used to analyze relationship between the retraction distance of TBS and potential risk factors including age, gender, course, length of bone defect, number of operations, size of TBS, transport distance, timing and time interval of removal of TBS fixator. Risk factors with significant level were further identified using multivariate linear regression. Results: Bivariate correlation showed that the timing of removal was negatively correlated with the retraction distance, and the time interval and transport distance were positively correlated with the retraction distance（p<0.05), the age, gender, course, length of bone defect, size of TBS and number of operations were not correlated with the retraction distance（p>0.05). Multivariate linear regression of the 3 risk factors showed that the timing of removal and time interval were the main risk factors affecting the retraction distance (p<0.05), but the transport distance was not (p>0.05). Conclusion: The traction forces of TBS endured from the soft tissues and the unconsolidated distracted callus have elastic properties, which can make retraction of TBS. The timing of removal and time interval are the main risk factors of the retraction of TBS. In the case of early removal, another external fixation or quickly converted to internal fixation should be performed to avoid the adverse effect of more retraction.