Trifocal bone transport by using monolateral rail system in treatment of bone defects caused by post-traumatic tibial osteomyelitis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Ainizier·yalikun , Alimujiang·abulait , Maimaiaili·yushan , REN Peng , MA Chuang ,  Aihemaitijiang·yusufu

Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China;

Corresponding author：

Aihemaitijiang·yusufu, Email: ahmatjang@163.com

Keywords：

Post-traumatic osteomyelitis; bone defect; trifocal bone transport; monolateral rail system

DOI：

10.7507/1002-1892.201912034

Video：

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Objective To study the effectiveness of trifocal bone transport by using monolateral rail system in the treatment of bone defects caused by post-traumatic tibial osteomyelitis.Methods The clinical data of 28 patients with tibial defects caused by post-traumatic osteomyelitis treated with trifocal bone transport technique by using monolateral rail system between January 2012 and June 2017 were retrospectively analyzed. There were 26 males and 2 females, aged 22-59 years (mean, 41.3 years). The causes of injury included 13 cases of traffic accident injury, 9 cases of falling from height, 4 cases of heavy object injury, and 2 cases of crushing injury. The disease duration was 4.5-17.0 months (mean, 7.1 months). The length of bone defect was 6.5-16.8 cm (mean, 10.3 cm). And the range of soft tissue defect ranged from 3.5 cm×2.0 cm to 18.0 cm×11.0 cm. The bone transporting time, external fixation time, duration of regenerate consolidation, and external fixation index were recorded, and the complications were observed. At last follow-up, the bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of the Ilizarov (ASAMI).Results All patients were successfully followed up after removing the external fixator with an average of 35 months (range, 24-65 months). The bone transporting time was 41-136 days (mean, 60.2 days), the external fixation time was 7.5-20.0 months (mean, 13.4 months), the external fixation index was 1.1-1.9 months/cm (mean, 1.4 months/cm), the duration of regenerate consolidation was 6.0-16.5 months (mean, 10.5 months). Pin tract infection occurred in 12 cases, delayed union on docking site was occurred in 9 cases, axial deviation was observed in 2 cases, poor regenerate consolidation was presented in 1 case, and refracture on docking site after fixator removal was occurred in 1 case. There was no recurrence of infection, amputation, vascular and neurologic complications, and osteofascial compartment syndrome. At last follow-up, according to ASAMI criterion, the bone healing results were excellent in 17 cases, good in 7 cases, and fair in 4 cases, with an excellent and good rate of 85.7%; the functional results were excellent in 15 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 89.3%.Conclusion Trifocal bone transport by using monolateral rail system is an effective method in the treatment of bone defect caused by post-traumatic osteomyelitis which can reduce bone transport time, external fixation time, and complications.

Citation： Ainizier·yalikun, Alimujiang·abulait, Maimaiaili·yushan, REN Peng, MA Chuang, Aihemaitijiang·yusufu. Trifocal bone transport by using monolateral rail system in treatment of bone defects caused by post-traumatic tibial osteomyelitis. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 862-868. doi: 10.7507/1002-1892.201912034 Copy

1.	Borzunov DY, Chevardin AV. Ilizarov non-free bone plasty for extensive tibial defects. Int Orthop, 2013, 37(4): 709-714.
2.	Papakostidis C, Bhandari M, Giannoudis PV. 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, 2013, 95-B(12): 1673-1680.
3.	艾合麦提江·玉素甫, 陈统一, 王晓峰, 等. 应用 Ilizarov 技术治疗长管状骨缺损性骨不连. 中华骨科杂志, 2006, 26(4): 247-251.
4.	Adaş M, Tekin AÇ, Bayraktar MK, et al. Effects of the lower extremity external fixators on the sexual life of males. Acta Orthop Traumatol Turc, 2016, 50(1): 76-81.
5.	Aktuglu K, Günay H, Alakbarov J. Monofocal bone transport technique for bone defects greater than 5 cm in tibia: our experience in a case series of 24 patients. Injury, 2016, 47(Suppl 6): S40-S46.
6.	Borzunov DY. Long bone reconstruction using multilevel lengthening of bone defect fragments. Int Orthop, 2012, 36(8): 1695-1700.
7.	Catagni MA, Azzam W, Guerreschi F, et al. Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects. Bone Joint J, 2019, 101-B(2): 162-169.
8.	Rohilla R, Siwach K, Devgan A, et al. Outcome of distraction osteogenesis by ring fixator in infected, large bone defects of tibia. J Clin Orthop Trauma, 2016, 7(Suppl 2): 201-209.
9.	Chaddha M, Gulati D, Singh AP, et al. Management of massive posttraumatic bone defects in the lower limb with the Ilizarov technique. Acta Orthop Belg, 2010, 76(6): 811-820.
10.	Sala F, Talamonti T, Agus MA. Tetrafocal leg reconstruction using combined Ilizarov/TSF technique. Musculoskelet Surg, 2011, 95(2): 151-155.
11.	Sala F, Thabet AM, Castelli F, et al. Bone transport for postinfectious segmental tibial bone defects with a combined ilizarov/taylor spatial frame technique. J Orthop Trauma, 2011, 25(3): 162-168.
12.	Paley D, Maar DC. Ilizarov bone transport treatment for tibial defects. J Orthop Trauma, 2000, 14(2): 76-85.
13.	Robert Rozbruch S, Weitzman AM, Tracey Watson J, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma, 2006, 20(3): 197-205.
14.	Lin CC, Chen CM, Chiu FY, et al. Staged protocol for the treatment of chronic tibial shaft osteomyelitis with Ilizarov’s technique followed by the application of intramedullary locked nail. Orthopedics, 2012, 35(12): e1769-e1774.
15.	Thakeb MF, Fayyad TA, ElGebeily MA, et al. Bifocal compression-distraction for combined bone and soft-tissue defects in post-traumatic tibial nonunion. J Orthop Trauma, 2019, 33(10): e372-e377.
16.	Chimutengwende-Gordon M, Mbogo A, Khan W, et al. Limb reconstruction after traumatic bone loss. Injury, 2017, 48(2): 206-213.
17.	Morris R, Hossain M, Evans A, et al. Induced membrane technique for treating tibial defects gives mixed results. Bone Joint J, 2017, 99-B(5): 680-685.
18.	Page PR, Trickett RW, Rahman SM, et al. The use of secure anonymised data linkage to determine changes in healthcare utilisation following severe open tibial fractures. Injury, 2015, 46(7): 1287-1292.
19.	McNally M, Ferguson J, Kugan R, et al. Ilizarov treatment protocols in the management of infected nonunion of the tibia. J Orthop Trauma, 2017, 31(Suppl 5): S47-S54.
20.	Wang H, Wei X, Liu P, et al. Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia. Medicine (Baltimore), 2017, 96(45): e8569.
21.	Makhdoom A, Kumar J, Siddiqui AA. Ilizarov external fixation: percutaneous gigli saw versus multiple drill-hole osteotomy techniques for distraction osteogenesis. Cureus, 2019, 11(6): e4973.
22.	Peek AC, Timms A, Chin KF, et al. Patterns of healing: a comparison of two proximal tibial osteotomy techniques. Strategies Trauma Limb Reconstr, 2016, 11(1): 59-62.
23.	Kiran M, Jee R. Bone transport in tibial gap non-union—A series of 25 cases. Open Journal of Orthopedics, 2012, 2(4): 144-149.
24.	Liu T, Yu X, Zhang X, et al. One-stage management of post-traumatic tibial infected nonunion using bone transport after debridement. Turkish Journal of Medical Sciences, 2012, 42(6): 1111-1120.
25.	Borzunov DY, Balaev PI, Subramanyam KN. Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients. Indian J Orthop, 2015, 49(5): 516-522.
26.	Tong K, Zhong Z, Peng Y, et al. Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. Injury, 2017, 48(7): 1616-1622.
27.	艾合买提江·玉素甫. 骨延长治疗近期关注热点. 中国修复重建外科杂志, 2018, 32(7): 849-853.
28.	姬涛, 郭卫, 杨荣利, 等. Orthofix 单边外固定架在骨肿瘤外科治疗中的应用. 中国修复重建外科杂志, 2017, 31(10): 1161-1167.
29.	Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol, 2019, 20(1): 22.
30.	Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res, 1994, (301): 10-18.
31.	Tsuchiya H, Tomita K, Shinokawa Y, et al. The Ilizarov method in the management of giant-cell tumours of the proximal tibia. J Bone Joint Surg (Br), 1996, 78(2): 264-269.
32.	Peng J, Min L, Xiang Z, et al. Ilizarov bone transport combined with antibiotic cement spacer for infected tibial nonunion. Int J Clin Exp Med, 2015, 8(6): 10058-10065.
33.	van Niekerk AH, Birkholtz FF, de Lange P, et al. Circular external fixation and cemented PMMA spacers for the treatment of complex tibial fractures and infected nonunions with segmental bone loss. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499017716242.
34.	Khan MS, Rashid H, Umer M, et al. Salvage of infected non-union of the tibia with an Ilizarov ring fixator. J Orthop Surg (Hong Kong), 2015, 23(1): 52-55.
35.	Selim NM. Ilizarov trifocal lengthening followed by intramedullary nailing for massive posttraumatic tibial bone defects. Acta Orthop Belg, 2013, 79(6): 706-710.
36.	Megas P, Saridis A, Kouzelis A, et al. The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method. Injury, 2010, 41(3): 294-299.
37.	Yin P, Zhang Q, Mao Z, et al. 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, 2014, 80(3): 426-435.

1. Borzunov DY, Chevardin AV. Ilizarov non-free bone plasty for extensive tibial defects. Int Orthop, 2013, 37(4): 709-714.
2. Papakostidis C, Bhandari M, Giannoudis PV. 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, 2013, 95-B(12): 1673-1680.
3. 艾合麦提江·玉素甫, 陈统一, 王晓峰, 等. 应用 Ilizarov 技术治疗长管状骨缺损性骨不连. 中华骨科杂志, 2006, 26(4): 247-251.
4. Adaş M, Tekin AÇ, Bayraktar MK, et al. Effects of the lower extremity external fixators on the sexual life of males. Acta Orthop Traumatol Turc, 2016, 50(1): 76-81.
5. Aktuglu K, Günay H, Alakbarov J. Monofocal bone transport technique for bone defects greater than 5 cm in tibia: our experience in a case series of 24 patients. Injury, 2016, 47(Suppl 6): S40-S46.
6. Borzunov DY. Long bone reconstruction using multilevel lengthening of bone defect fragments. Int Orthop, 2012, 36(8): 1695-1700.
7. Catagni MA, Azzam W, Guerreschi F, et al. Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects. Bone Joint J, 2019, 101-B(2): 162-169.
8. Rohilla R, Siwach K, Devgan A, et al. Outcome of distraction osteogenesis by ring fixator in infected, large bone defects of tibia. J Clin Orthop Trauma, 2016, 7(Suppl 2): 201-209.
9. Chaddha M, Gulati D, Singh AP, et al. Management of massive posttraumatic bone defects in the lower limb with the Ilizarov technique. Acta Orthop Belg, 2010, 76(6): 811-820.
10. Sala F, Talamonti T, Agus MA. Tetrafocal leg reconstruction using combined Ilizarov/TSF technique. Musculoskelet Surg, 2011, 95(2): 151-155.
11. Sala F, Thabet AM, Castelli F, et al. Bone transport for postinfectious segmental tibial bone defects with a combined ilizarov/taylor spatial frame technique. J Orthop Trauma, 2011, 25(3): 162-168.
12. Paley D, Maar DC. Ilizarov bone transport treatment for tibial defects. J Orthop Trauma, 2000, 14(2): 76-85.
13. Robert Rozbruch S, Weitzman AM, Tracey Watson J, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma, 2006, 20(3): 197-205.
14. Lin CC, Chen CM, Chiu FY, et al. Staged protocol for the treatment of chronic tibial shaft osteomyelitis with Ilizarov’s technique followed by the application of intramedullary locked nail. Orthopedics, 2012, 35(12): e1769-e1774.
15. Thakeb MF, Fayyad TA, ElGebeily MA, et al. Bifocal compression-distraction for combined bone and soft-tissue defects in post-traumatic tibial nonunion. J Orthop Trauma, 2019, 33(10): e372-e377.
16. Chimutengwende-Gordon M, Mbogo A, Khan W, et al. Limb reconstruction after traumatic bone loss. Injury, 2017, 48(2): 206-213.
17. Morris R, Hossain M, Evans A, et al. Induced membrane technique for treating tibial defects gives mixed results. Bone Joint J, 2017, 99-B(5): 680-685.
18. Page PR, Trickett RW, Rahman SM, et al. The use of secure anonymised data linkage to determine changes in healthcare utilisation following severe open tibial fractures. Injury, 2015, 46(7): 1287-1292.
19. McNally M, Ferguson J, Kugan R, et al. Ilizarov treatment protocols in the management of infected nonunion of the tibia. J Orthop Trauma, 2017, 31(Suppl 5): S47-S54.
20. Wang H, Wei X, Liu P, et al. Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia. Medicine (Baltimore), 2017, 96(45): e8569.
21. Makhdoom A, Kumar J, Siddiqui AA. Ilizarov external fixation: percutaneous gigli saw versus multiple drill-hole osteotomy techniques for distraction osteogenesis. Cureus, 2019, 11(6): e4973.
22. Peek AC, Timms A, Chin KF, et al. Patterns of healing: a comparison of two proximal tibial osteotomy techniques. Strategies Trauma Limb Reconstr, 2016, 11(1): 59-62.
23. Kiran M, Jee R. Bone transport in tibial gap non-union—A series of 25 cases. Open Journal of Orthopedics, 2012, 2(4): 144-149.
24. Liu T, Yu X, Zhang X, et al. One-stage management of post-traumatic tibial infected nonunion using bone transport after debridement. Turkish Journal of Medical Sciences, 2012, 42(6): 1111-1120.
25. Borzunov DY, Balaev PI, Subramanyam KN. Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients. Indian J Orthop, 2015, 49(5): 516-522.
26. Tong K, Zhong Z, Peng Y, et al. Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. Injury, 2017, 48(7): 1616-1622.
27. 艾合买提江·玉素甫. 骨延长治疗近期关注热点. 中国修复重建外科杂志, 2018, 32(7): 849-853.
28. 姬涛, 郭卫, 杨荣利, 等. Orthofix 单边外固定架在骨肿瘤外科治疗中的应用. 中国修复重建外科杂志, 2017, 31(10): 1161-1167.
29. Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol, 2019, 20(1): 22.
30. Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res, 1994, (301): 10-18.
31. Tsuchiya H, Tomita K, Shinokawa Y, et al. The Ilizarov method in the management of giant-cell tumours of the proximal tibia. J Bone Joint Surg (Br), 1996, 78(2): 264-269.
32. Peng J, Min L, Xiang Z, et al. Ilizarov bone transport combined with antibiotic cement spacer for infected tibial nonunion. Int J Clin Exp Med, 2015, 8(6): 10058-10065.
33. van Niekerk AH, Birkholtz FF, de Lange P, et al. Circular external fixation and cemented PMMA spacers for the treatment of complex tibial fractures and infected nonunions with segmental bone loss. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499017716242.
34. Khan MS, Rashid H, Umer M, et al. Salvage of infected non-union of the tibia with an Ilizarov ring fixator. J Orthop Surg (Hong Kong), 2015, 23(1): 52-55.
35. Selim NM. Ilizarov trifocal lengthening followed by intramedullary nailing for massive posttraumatic tibial bone defects. Acta Orthop Belg, 2013, 79(6): 706-710.
36. Megas P, Saridis A, Kouzelis A, et al. The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method. Injury, 2010, 41(3): 294-299.
37. Yin P, Zhang Q, Mao Z, et al. 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, 2014, 80(3): 426-435.

Chinese Journal of Reparative and Reconstructive Surgery

Trifocal bone transport by using monolateral rail system in treatment of bone defects caused by post-traumatic tibial osteomyelitis

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