COMPARISON OF THE VALUES OF EFT (External Fixation Time) IN THE TREATMENT OF LOWER LEG OPEN FRACTURES AND NON-UNIONS WITH THE METHOD OF COMPRESSION-DISTRACTION OSTEOSYNTHESIS BY ILIZAROV
Abstract
Open tibial fractures rank among the most common injuries to long bones, with an annual incidence of 3.4 per 100,000. Complications such as non-unions may arise in 2-10% of these injuries. The Ilizarov method offers a universal opportunity for definitive treatment in both conditions. This retrospective unicentric cohort study aims to assess the value of External Fixation Time (EFT) in patients with open tibial fractures and non-unions treated with compression-distraction osteosynthesis by Ilizarov, followed by a comparative analysis. We evaluated 30 patients treated between 2014 and 2019 for open fractures or non-union of the tibia. The average ages for the two groups were 46 and 50 years, respectively. The latter group had an average of 1.6 prior surgical treatments, with approximately 14 months elapsed since the injury. All subjects examined achieved bone healing. The average EFT values were 160 and 210 days for the treatment of open fractures and non-unions, respectively. There is a statistically significant difference in the EFT values between both groups. 97% of the patients demonstrated satisfactory radiographic results based on the ASAMI scoring system.Treatment with compression-distraction osteosynthesis by Ilizarov proved effective for both open fractures and non-unions of the lower leg. A statistically significant difference exists between the two groups in terms of EFT values representing the duration of treatment.
Keywords: open fractures, non-unions, Ilizarov, EFT.
References
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25. Schottel PC, Muthusamy S, Rozbruch SR. “Distal tibial periarticular nonunions: ankle salvage with bone transport.†J Orthop Trauma.2014 Jun;28(6):e146-52
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29. Busse JW, Bhandari M, Kulkarni AV, Tunks E. The effect of low-intensity pulsed ultrasound therapy on time to fracture healing: a meta-analysis. CMAJ. 2002 Feb 19. 166 (4):437-41. [QxMD MEDLINE Link].
30. Hak DJ. Management of aseptic tibial nonunion. J Am Acad Orthop Surg. 2011 Sep. 19 (9):563-73. [QxMD MEDLINE Link].
31. Wu CC, Shih CH. Comparison of dynamic compression plating and reamed intramedullary nailing in the treatment of aseptic tibial shaft nonunions. Contemp Orthop. 1994 Jan. 28 (1):28-33. [QxMD MEDLINE Link].
32. 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.
33. Dailey HL, Wu KA, Wu PS, McQueen MM, Court-Brown CM. Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing: Risk Factors Based on a Single-Center Review of 1003 Patients. J Orthop Trauma. 2018 Jul. 32 (7):e263-e269. [QxMD MEDLINE Link].
34. Tanner M, Vlachopoulos W, Findeisen S, Miska M, Ober J, Hagelskamp S, et al. Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis. J Clin Med. 2019 Aug 22. 8 (9):[QxMD MEDLINE Link]. [Full Text].
2. Behrens F, Searls K. External fixation of the tibia. Basic concepts and prospective evaluation. J Bone Joint Surg Br. 1986 Mar. 68 (2):246-54. [Medline].
3. Court-Brown CM, Bugler KE, Clement ND, Duckworth AD, McQueen MM. The epidemiology of open fractures in adults. A 15-year review. Injury 2012;43:891-7. [PubMed] [Google Scholar]
4. Larsen P, Elsoe R, Hansen SH, et al. Incidence and epidemiology of tibial shaft fractures. Injury 2015;46:746-50. [PubMed] [Google Scholar]
5. Jenkins PJ, Keating JF, Simpson AH. Fractures of the tibial shaft. Surgery 2010;28:489-93. [Google Scholar]
6. 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.
7. 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.
8. Wiss DA, Stetson WB. Tibial Nonunion: Treatment Alternatives. J Am Acad Orthop Surg. 1996 Oct. 4 (5):249-257. [QxMD MEDLINE Link].
9. Zura R, Watson JT, Einhorn T, Mehta S, Della Rocca GJ, Xiong Z, et al. An inception cohort analysis to predict nonunion in tibia and 17 other fracture locations. Injury. 2017 Jun. 48 (6):1194-1203. [QxMD MEDLINE Link]. [Full Text].
10. McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br. 1996 Jan. 78 (1):95-8. [QxMD MEDLINE Link]
11. Fong K, Truong V, Foote CJ, Petrisor B, Williams D, Ristevski B, et al. Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study. BMC Musculoskelet Disord. 2013 Mar 22. 14:103. [QxMD MEDLINE Link]. [Full Text].
12. Schmitz MA, Finnegan M, Natarajan R, Champine J. Effect of smoking on tibial shaft fracture healing. Clin Orthop Relat Res. 1999 Aug. 184-200. [QxMD MEDLINE Link].
13. Fader L, Whitaker J, Lopez M, Vivace B, Parra M, Carlson J, et al. Tibia fractures and NSAIDs. Does it make a difference? A multicenter retrospective study. Injury. 2018 Dec. 49 (12):2290-2294. [QxMD MEDLINE Link].
14. Okike K, Bhattacharyya T. Trends in the management of open fractures. A critical analysis. J Bone Joint Surg [Am] 2006;88-A:2739-48. [PubMed] [Google Scholar]
15. Zalavras CG, Patzakis MJ. Open fractures: evaluation and management. J Am Acad Orthop Surg 2003;11:212-9. [PubMed] [Google Scholar]
16. Pape H-C, Webb LX. History of open wound and fracture treatment. J Orthop Trauma 2008;22(suppl):S133-4. [PubMed] [Google Scholar]
17. Chen AT, Vallier HA. Noncontiguous and open fractures of the lower extremity: Epidemiology, complications, and unplanned procedures. Injury 2016;47:742-7. [PubMed] [Google Scholar]
18. O'Toole, Robert V. MD*; Gary, Joshua L. MD†; Reider, Lisa PhD‡; Bosse, Michael J. MD§; Gordon, Wade T. MD‖; Hutson, James MD¶; Quinnan, Stephen M. MD¶; Castillo, Renan C. PhD‡; Scharfstein, Daniel O. ScD**; MacKenzie, Ellen J. PhD‡; METRC A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation (FIXIT Study), Journal of Orthopaedic Trauma: April 2017 - Volume 31 - Issue - p S10-S17 doi: 10.1097/BOT.0000000000000804
19. Ilizarov, Gavril A. Transosseous Osteosynthesis: Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue, Springer Science & Business Media, 2012
20. Limb Lengthening and Reconstruction Surgery Case Atlas, Springer International Publishing, Editors: Rozbruch, S. Robert, Hamdy, Reggie (Eds.) Copyright: 2015
21.Gubin AV, Borzunov DY, Marchenkova LO, Malkova TA, Smirnova IL. Contribution of G.A. Ilizarov to bone reconstruction: historical achievements and state of the art. Strategies Trauma Limb Reconstr. 2016;11(3):145â€152. doi:10.1007/s11751-016-0261-7
22. Compton, Jocelyn & Fragomen, Austin & Rozbruch, S Robert. (2015). Skeletal Repair in Distraction Osteogenesis: Mechanisms and Enhancements. JBJS Reviews. 3. e2-e2. 10.2106/JBJS.RVW.N.00107.
23. Goldstein RY, Jordan CJ, McLaurin TM, Grant A. The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis. Bull Hosp Jt Dis (2013). 2013;71(1):96â€103.
24. Steele J, Pedersen JB, Jay S, Lohn J, Nielsen D, Vesely M, et al. Gustilo-Anderson type III tibial fractures have poor functional outcomes in patients over 75 years. J Clin Orthop Trauma. 2020 Feb. 11 (Suppl 1):S71-S75. [Medline].
25. Schottel PC, Muthusamy S, Rozbruch SR. “Distal tibial periarticular nonunions: ankle salvage with bone transport.†J Orthop Trauma.2014 Jun;28(6):e146-52
26. Reed LK, Mormino MA. Distal tibia nonunions. Foot Ankle Clin. 2008 Dec. 13 (4):725-35. [QxMD MEDLINE Link].
27.Paley D, Maar DC. “Ilizarov bone transport treatment for tibial defects.†J Orthop Trauma. 2000 Feb;14(2):76-85.
28. Valdes MA, Thakur NA, Namdari S, Ciombor DM, Palumbo M. Recombinant bone morphogenic protein-2 in orthopaedic surgery: a review. Arch Orthop Trauma Surg. 2009 Dec. 129 (12):1651-7. [QxMD MEDLINE Link].
29. Busse JW, Bhandari M, Kulkarni AV, Tunks E. The effect of low-intensity pulsed ultrasound therapy on time to fracture healing: a meta-analysis. CMAJ. 2002 Feb 19. 166 (4):437-41. [QxMD MEDLINE Link].
30. Hak DJ. Management of aseptic tibial nonunion. J Am Acad Orthop Surg. 2011 Sep. 19 (9):563-73. [QxMD MEDLINE Link].
31. Wu CC, Shih CH. Comparison of dynamic compression plating and reamed intramedullary nailing in the treatment of aseptic tibial shaft nonunions. Contemp Orthop. 1994 Jan. 28 (1):28-33. [QxMD MEDLINE Link].
32. 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.
33. Dailey HL, Wu KA, Wu PS, McQueen MM, Court-Brown CM. Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing: Risk Factors Based on a Single-Center Review of 1003 Patients. J Orthop Trauma. 2018 Jul. 32 (7):e263-e269. [QxMD MEDLINE Link].
34. Tanner M, Vlachopoulos W, Findeisen S, Miska M, Ober J, Hagelskamp S, et al. Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis. J Clin Med. 2019 Aug 22. 8 (9):[QxMD MEDLINE Link]. [Full Text].
Published
2023-12-26
How to Cite
SHESHOSKI, Ognen et al.
COMPARISON OF THE VALUES OF EFT (External Fixation Time) IN THE TREATMENT OF LOWER LEG OPEN FRACTURES AND NON-UNIONS WITH THE METHOD OF COMPRESSION-DISTRACTION OSTEOSYNTHESIS BY ILIZAROV.
Journal of Morphological Sciences, [S.l.], v. 6, n. 3, p. 46-55, dec. 2023.
ISSN 2545-4706.
Available at: <https://jms.mk/jms/article/view/vol6no3-7>. Date accessed: 21 dec. 2024.
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