COMPRESSION - DISTRACTION OSTEOGENESIS WITH ILIZAROV APPARATUS IN THE TREATMENT OF TIBIAL NON-UNIONS WITH BONE DEFECTS
Treatment of the long bones defects and non-unions are among the most challenging cases to solve in the orthopaedic surgery. In these rare and difficult cases the method of compression - distraction osteogenesis can be the only limb salvage procedure to promote healing of the bone with comprehensive approach to all aspects of the condition. Objective of this retrospective one centred study is to perform both radiological and functional evaluation of the treatment of tibial non-unions with segmental bone defects or significant axial deviation using the method of compression - distraction osteogenesis with the Ilizarov apparatus. In the period between 2006 and 2018 15 patients were surgically treated using this method (in 9 of them as an intercalary bone transport and in other 6 as a continuous distraction with correction of axial deviation). There was an average of 22.9 months from injury and all of them underwent previous surgeries with an average of 2.3/patient. ASAMI (Association for studying and application of Ilizarov methods) scoring system was used for both radiological (bone) and functional results. Also patient’s satisfaction with the achieved results was ranked postoperatively. 80% of the patients achieved satisfactory (good and excellent) bone results and 73% satisfactory functional results. Approximately 87% of the patients were personally satisfied with the achieved results. The method of compression - distraction osteogenesis using Ilizarov apparatus proved to be effective as a limb salvage procedure with high degree of excellent and good both radiological and functional results.
Keywords: compression-distraction osteogenesis, Ilizarov, non-union, bone defect
Bone Joint Surg Br. 1996 Jan. 78(1):95-8.
2. Roddy E, DeBaun MR, Daoud-Gray A, Yang YP, Gardner MJ. “Treatment of critical-sized bone defects: clinical
and tissue engineering perspectives.” Eur J Orthop Surg Traumatol. 2018 Apr;28(3):351-362.
3. Aronson J. “Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method.”Journal
for Bone and Joint Surgery 1997 Am 79:1243–1258
4. Aronson J, Harrison B, Boyd CM, Cannon DJ, Lubansky HJ. “Mechanical induction of osteogenesis: the
importance of pin rigidity.” J Pediatr Orthop 1998 8:396–401
5. Aronson J, Harrison B, Boyd CM, Cannon DJ, Lubansky HJ, Stewart C “Mechanical induction of osteogenesis.”
Prelim Stud Ann Clin Lab Sci 1988 18:195–203
6. Aronson J, Johnson E, Harp JH “Local bone transportation for treatment of intercalary defects by the Ilizarov
technique. Biomechanical and clinical considerations.” Clin Orthop Relat Res 1989 243:71–79
7. Schottel PC, Muthusamy S, Rozbruch SR. “Distal tibial periarticular nonunions: ankle salvage with bone
transport.” J Orthop Trauma.2014 Jun;28(6):e146-52
8. Audigé L, Griffin D, Bhandari M, Kellam J, Rüedi TP. “Path analysis of factors for delayed healing and nonunion
in 416 operatively treated tibial shaft fractures.” Clin Orthop Relat Res. 2005 Sep.438:221-32.
9. Will RE, Fleming ME, Lafferty PM, Fletcher JW, Cole PA. “Low complication rate associated with raising mature
flap for tibial nonunion reconstruction.” Journal of Trauma.2011 Dec. 71(6):1709-14.
10. Paley D, Maar DC. “Ilizarov bone transport treatment for tibial defects.” J Orthop Trauma. 2000 Feb;14(2):76-
13. Yin P, Ji Q, Li T et al.. “A Systematic Review and Meta-Analysis of Ilizarov Methods in the Treatment of Infected
Nonunion of Tibia and Femur.” PLoS One.2015 Nov 3;10(11):e0141973.
11. Roddy E, DeBaun MR, Daoud-Gray A, Yang YP, Gardner MJ. “Treatment of critical-sized bone defects: clinical
and tissue engineering perspectives.” Eur J Orthop Surg Traumatol.2018 Apr;28(3):351-362.
12. Robert Rozbruch S, Weitzman AM, Tracey Watson J, Freudigman P, Katz HV, Ilizarov S. “Simultaneous
treatment of tibial bone and soft-tissue defects with the Ilizarov method.” J Orthop Trauma.2006
14. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. “Ilizarov treatment of tibial nonunions with
bone loss.” Clin Orthop Relat Res.1989 Apr;(241):146-65.