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Use of locked plates and mono-rail fixator in segmental tibial defects: A prospective interventional study.

作者信息

Kunwar Bom Bahadur, Maheshwari Vikas, Dhingra Mohit, Bhagat Saroj, Pv Chanakya, Vardhan Sunit

机构信息

Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India.

出版信息

J Orthop. 2023 Aug 14;44:47-52. doi: 10.1016/j.jor.2023.08.003. eCollection 2023 Oct.


DOI:10.1016/j.jor.2023.08.003
PMID:37664557
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10471829/
Abstract

INTRODUCTION: The management of gap non-union is a major challenge to both the clinician and the patient as it is technically difficult, time-intensive, and physically arduous for the patient along with an unpredictable result. Gap non-union can arise from extrusion of bony fragment at the time of trauma or after debridement of unhealthy bone later. Moreover, Tibia because of its subcutaneous anatomy can easily undergo bone-loss and segmental defect. Among various methods available for managing gap non-union of tibia distraction osteogenesis using either ilizarov fixator or mono-rail fixator is the most popular one. Here we present functional and bony outcomes of combined use of locking plate and Limb Reconstruction System (LRS) in tibial gap non-union and assess whether it decreases fixator time and related complications. PATIENTS AND METHODS: A prospective intervention study constituting 10 patients with Paley's type B1 tibial gap non-union over a period of 22months. In first stage, debridement was done; tibial locking plate and mono-rail fixator were applied along with corticomy at proximal tibia. Distraction was started 7-14 days later. At the end of distraction phase, fixator was removed and transported segment was fixed with screws with or without bone grafting at docking site. Patients were followed up every 6 weeks for radiological and clinical assessment. Functional assessment using Application for the Study and Application of the Method of Ilizarov (ASAMI) functional score, and Musculoskeletal Tumour Society (MSTS) functional score while bone outcome was assessed with ASAMI bone score. Quality of regenerate was assessed by Fernandez-Esteve grading. Detailed scoring was done at the time of index surgery, at the time of LRS removal and at the time of consolidation phase. RESULTS: All the 10 patients were male with mean age of 33 years. The mean defect size was 4.94 cm after debridement. Minimum duration of follow up was 30 weeks after removal of LRS. Mean duration between trauma and inclusion in the study was 17.7 months. The median external fixator index was 15.63 days/cm. The complication rate was 1.3/patient. According to Paley's classification, there were eleven problems and two obstacles, and no true complications. Both ASAMI bone score and functional scores were excellent in three and good in six patients. The median MSTS composite score was 76.66%. CONCLUSION: The integrated fixation is an effective and satisfactory method enabling early external fixator removal with low rate of complication. So, this technique can be recommended for the management of segmental tibial defects. LEVEL OF EVIDENCE: II.

摘要

相似文献

[1]
Use of locked plates and mono-rail fixator in segmental tibial defects: A prospective interventional study.

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本文引用的文献

[1]
Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis.

Sci Rep. 2022-6-1

[2]
Management of complex non union of tibia using rail external fixator.

J Clin Orthop Trauma. 2020-7

[3]
[Application of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019-3-15

[4]
The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate.

Bone Joint J. 2018-8

[5]
Ilizarov Treatment Protocols in the Management of Infected Nonunion of the Tibia.

J Orthop Trauma. 2017-10

[6]
Infected tibia defect fractures treated with the Masquelet technique.

Medicine (Baltimore). 2017-5

[7]
Fracture healing: A review of clinical, imaging and laboratory diagnostic options.

Injury. 2017-6

[8]
Ilizarov ring fixator in the management of infected non-unions of tibia.

SICOT J. 2015-7-29

[9]
Effectiveness of ilizarov frame fixation on functional outcome in aseptic tibial gap non-union.

J Pak Med Assoc. 2015-11

[10]
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. 2014-9

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