Abstract
BackgroundTibia infected nonunion and chronic osteomyelitis are challenging clinical presentations. Bone transportation with external or hybrid fixators (combined external and internal fixators) is versatile to solve these problems. However, the infection-free rates of these fixator systems are unknown. Additionally, the prognosis factors for results of bone transportation are obscure. Therefore, this systematic review and meta-analysis was conducted to answer these questions.MethodsA systematic review was conducted following the PRISMA-IPD guidelines. Relevant publications from January 1995 to September 2018 were compiled from Medline, Embase, and Cochrane. The infection-free rates of external and hybrid fixators were achieved by synthesizing aggregate data and individual participant data (IPD). IPD was analyzed by two-stage method with logistical regression to identify prognosis factors of sequelae.ResultsTwenty-two studies with 518 patients were identified, including 11 studies with 167 patients’ IPD, and 11 studies with 351 patients’ aggregate data. The infection-free rate of hybrid fixator group was 86% (95%CI: 79–94%), lower than that of external fixator which was 97% (95%CI: 95–98%,). The number of previous surgeries was found predict factor of bone union sequelae (p = 0.04) and function sequelae(p < 0.01); The external fixation time was found predict factor of function sequelae (p = 0.015).ConclusionsHybrid fixators may be associated with a greater risk of infection-recurrence in the treatment of tibia infected nonunion and chronic osteomyelitis. The number of previous surgeries and external fixation time can be used as predictors of outcomes. Proper fixators and meticulously designed surgery are important to avoid unexpected operations and shorten external fixation time.
Highlights
Tibia infected nonunion and chronic osteomyelitis are challenging clinical presentations
Studies were considered acceptable for inclusion if the following criteria were fulfilled: (1) studies treated adult patients diagnosed of tibia infectious non-union or osteomyelitis; (2) studies with a minimum sample of 5 aforementioned consecutive patients were treated with multifocal bone transport technique; For individual participant data (IPD) collection, each subgroup of fixator systems should contain no less than 5 patients
Hybrid fixators were applied on 63 patients, while external fixators were applied on 454 patients (Table 1)
Summary
Tibia infected nonunion and chronic osteomyelitis are challenging clinical presentations. Tibial infected nonunion and chronic posttraumatic osteomyelitis are common clinical presentations which pose substantial burdens on both patients and society [1, 2]. Their treatment remains a large challenge; most cases are associated with infection caused by antibiotic-resistant bacteria, bone and soft tissue loss, deformities, and limb-length discrepancy [3, 4]. The procedure of bone transportation could be divided into distraction and consolidation phases: After corticectomy in metaphysis, the lost tissue is compensated by gradual distraction of healthy bone segment towards the defect site, and consequent consolidation follows when bone
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