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International Orthopaedics

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15-03-2024 | Refracture | Original Paper

Refracture-related bone transport of tibia: technical notes and preliminary clinical results in nineteen cases

Authors: Xiaochen Tian, Yanlong Zhang, Shibo Liu, Wenfang Zhai, Junchuan Liu, Qing Lu, Yong Wang, Aqin Peng

Published in: International Orthopaedics | Issue 5/2024

Abstract

Purpose

Refracture is one of the main complications of bone transport, which brings additional physical and mental burden to surgeries and patients. We aimed to raise a new classification system of refracture-related bone transport based on the Simpson classification and to present our experience on treatment.

Methods

This retrospective analysis included 19 patients with refracture-related bone transport (average age of 37.7 years; 18 men). We developed a modified Simpson classification system to assist decision-making (conservative versus surgical). The ASAMI criteria were used to assess the outcomes at last follow-up.

Results

The mean follow-up was 12.3 ± 3.2 months. Complete union was achieved in all patients, with no reinfection. Based on the modified Simpson classification, refracture was Ia type (within regeneration area) in three cases, Ib (collapsed fracture at the regeneration area) in one case, Ic (stress fracture) in three cases, II (at the junction between the regenerate and original bone) in one case, III (at the docking site) in nine cases, and V (at distant site) in two cases. Refracture was managed conservatively in six cases and surgically in 13 cases. Average time to bone union was 2.8 ± 1.2 months in the conservative group versus 4.4 ± 1.4 months in the surgery group. Assessment at the final follow-up using the ASAMI criteria revealed excellent bone result in all patients, excellent functional results in six patients (31.6%), and good functional results in 13 patients.

Conclusions

The modified Simpson classification could include refracture at the docking site and stress fracture in the regeneration zone and provide some guidance in determining the appropriate treatment strategy.

Aktuglu K, Erol K, Vahabi A (2019) Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol: Off J Ital Soc Orthop Traumatol 20(1):22. https://doi.org/10.1186/s10195-019-0527-1CrossRef

Simpson AH, Kenwright J (2000) Fracture after distraction osteogenesis. J Bone Joint Surg Br 82(5):659–665. https://doi.org/10.1302/0301-620x.82b5.9945CrossRefPubMed

Yin P, Ji Q, Li T, Li J, Li Z, Liu J, Wang G, Wang S, Zhang L, Mao Z, Tang P (2015) A systematic review and meta-analysis of ilizarov methods in the treatment of infected nonunion of tibia and femur. PLoS One 10(11):e0141973. https://doi.org/10.1371/journal.pone.0141973CrossRefPubMedPubMedCentral

Liu Y, Yushan M, Liu Z, Liu J, Ma C, Yusufu A (2020) Complications of bone transport technique using the Ilizarov method in the lower extremity: a retrospective analysis of 282 consecutive cases over 10 years. BMC Musculoskelet Disord 21(1):354. https://doi.org/10.1186/s12891-020-03335-wCrossRefPubMedPubMedCentral

Papakostidis C, Bhandari M, Giannoudis PV (2013) Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. Bone Joint J 95-B(12):1673–1680. https://doi.org/10.1302/0301-620X.95B12.32385CrossRefPubMed

Quinnan SM (2017) Segmental bone loss reconstruction using ring fixation. J Orthop Trauma 31(Suppl 5):S42–S46. https://doi.org/10.1097/BOT.0000000000000985CrossRefPubMed

Zhang Y, Wang Y, Di J, Peng A (2018) Double-level bone transport for large post-traumatic tibial bone defects: a single centre experience of sixteen cases. Int Orthop 42(5):1157–1164. https://doi.org/10.1007/s00264-017-3684-yCrossRefPubMed

Hosny GA, Singer MS, Hussein MA, Meselhy MA (2021) Refracture after Ilizarov fixation of infected ununited tibial fractures-an analysis of eight hundred and twelve cases. Int Orthop 45(8):2141–2147. https://doi.org/10.1007/s00264-021-05089-zCrossRefPubMed

Chaddha M, Gulati D, Singh AP, Singh AP, Maini L (2010) Management of massive posttraumatic bone defects in the lower limb with the Ilizarov technique. Acta Orthop Belg 76(6):811–820PubMed

10.

Khan MS, Rashid H, Umer M, Qadir I, Hafeez K, Iqbal A (2015) Salvage of infected non-union of the tibia with an Ilizarov ring fixator. J Orthop Surg 23(1):52–55. https://doi.org/10.1177/230949901502300112CrossRef

11.

Maini L, Chadha M, Vishwanath J, Kapoor S, Mehtani A, Dhaon BK (2000) The Ilizarov method in infected nonunion of fractures. Injury 31(7):509–517. https://doi.org/10.1016/s0020-1383(00)00036-xCrossRefPubMed

12.

Yin P, Zhang Q, Mao Z, Li T, Zhang L, Tang P (2014) The treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator and a systematic review of infected tibial nonunion treated by Ilizarov methods. Acta Orthop Belg 80(3):426–435PubMed

13.

Dendrinos GK, Kontos S, Lyritsis E (1995) Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. J Bone Joint Surg Am 77(6):835–846. https://doi.org/10.2106/00004623-199506000-00004CrossRefPubMed

14.

Song HR, Cho SH, Koo KH, Jeong ST, Park YJ, Ko JH (1998) Tibial bone defects treated by internal bone transport using the Ilizarov method. Int Orthop 22(5):293–297. https://doi.org/10.1007/s002640050263CrossRefPubMedPubMedCentral

15.

Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res 239:263–285CrossRef

16.

Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 238:249–281CrossRef

17.

Kinik H, Kalem M (2021) Ilizarov segmental bone transport of infected tibial nonunions requiring extensive debridement with an average distraction length of 9,5 centimetres. Is it safe? Injury 52(8):2425–2433. https://doi.org/10.1016/j.injury.2019.12.025CrossRefPubMed

18.

McNally M, Ferguson J, Kugan R, Stubbs D (2017) Ilizarov treatment protocols in the management of infected nonunion of the tibia. J Orthop Trauma 31(Suppl 5):S47–S54. https://doi.org/10.1097/BOT.0000000000000987CrossRefPubMed

19.

Marais LC, Ferreira N (2015) Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis. Strateg Trauma Limb Reconstr 10(1):27–33. https://doi.org/10.1007/s11751-015-0221-7CrossRef

20.

Lai KA, Lin CJ, Chen JH (2002) Application of locked intramedullary nails in the treatment of complications after distraction osteogenesis. J Bone Joint Surg Br 84(8):1145–1149. https://doi.org/10.1302/0301-620x.84b8.13085CrossRefPubMed

Title: Refracture-related bone transport of tibia: technical notes and preliminary clinical results in nineteen cases
Authors: Xiaochen Tian
Yanlong Zhang
Shibo Liu
Wenfang Zhai
Junchuan Liu
Qing Lu
Yong Wang
Aqin Peng
Publication date: 15-03-2024
Publisher: Springer Berlin Heidelberg
Keywords: Refracture
External Fixator
Bone Defect
Published in: International Orthopaedics / Issue 5/2024
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-024-06141-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Refracture-related bone transport of tibia: technical notes and preliminary clinical results in nineteen cases

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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