Management Of Tibial Defects Research Articles

Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved.

Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use. To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes. Three databases (PubMed, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period (2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results, complications and described large patient samples (not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded. Fifty full-text articles and reviews on distraction osteogenesis were chosen. Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously (bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion. The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.

Unilateral Orthofix external fixation for tibial defects

Objective To explore the curative effects of unilateral Orthofix external fixation in the treatment of tibial defects. Methods From June 2012 to February 2016, we treated 19 patients with tibial defects using unilateral Orthofix external fixation. They were 14 men and 5 women, aged from 26 to 79 years (mean, 43.0 years). The right tibia was involved in 12 cases and the left tibia in 7. The soft tissue defects averaged 6.4 cm×3.7 cm. The mean bone defect before bone transport was 8.9 cm in length. The anteroposterior and lateral X-ray films of the affected tibia were taken regularly after surgery. Edwards tibial fracture scores were used to evaluate the functional recovery and complications of the affected limb at final follow-ups. Results All the patients were followed up for 10 to 40 months (average, 18.5 months). Bone union time ranged from 4 to 16 months (average, 9.0 months). Lengths of bone transport ranged from 6 to 10 cm (average, 7.8 cm). All the bone defects were reconstructed. According to the Edwards scoring at the final follow-ups, 10 cases were rated as excellent, 6 as good and 3 as poor. Complications were observed in 4 cases, giving a complication rate of 21.1%. Conclusion Unilateral Orthofix external fixation and bone transport can lead to preferable curative effects in the management of tibial defects. Key words: Tibia; Bone defects; External fixator; Bone transport

The role of the Ilizarov fixator in management of tibial defect

The role of the Ilizarov fixator in management of tibial defect

Management of Tibial Defect in TKA using Artificial Materials

Management of Tibial Defect in TKA using Artificial Materials

Management of Tibial Defects in Total Knee Arthroplasty A Biomechanical Study

Peripheral deficiencies of tibial bone stock must be appropriately addressed at total knee arthroplasty to help ensure stability of the tibial component. Conversion of the oblique shaped peripheral defects into defects with vertical and horizontal surfaces, before repair, should lead to improved stability of tibial component fixation. In vitro testing revealed that conversion of the oblique wedge defect into a stepped pattern resulted in improved rigidity of the system when testing five specimens with a 20 degrees peripheral defect (wedge stiffness 25.5 +/- 1.08 versus step stiffness 32.4 +/- 1.72; p < 0.01) and five specimens with a 35 degrees defect (wedge stiffness 18.7 +/- 0.74 versus step stiffness 25.6 +/- 0.85; p < 0.0001). Improved rigidity of the system was further illustrated when a fibrous interface was introduced between the bone and cement surfaces (wedge stiffness 4.8 +/- 0.6 versus step stiffness 29.9 +/- 1.4; p < 0.0001). One hundred percent of wedge shaped cement constructs failed and slipped off, while none of the step shaped constructs described herein failed at the cement to bone interface. There were no statistically significant differences in stiffness with the incorporation of a metal wedge or block into the system when compared with the cement repaired stepped pattern. These biomechanical studies suggest that alterations in the configuration of peripheral defects can create a more rigid system that should ultimately result in improved support to the tibial component overlying these defects.