BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone...BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.展开更多
A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was valida...A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was validated through finite element analysis(FEA)and biomechanical tests.The tibia with inhomogeneous material properties was reconstructed according to computed tomography images,and different components were designed to simulate the operation.Minimum compliance TO subject to a volume fraction constraint combined with a graded lattice structure was utilized to redesign the prosthesis.FEA was performed to evaluate the mechanical performances of the tibia and implants after optimization,including stress,micromotion,and strain energy.The results were analyzed by paired-samples t tests,and p<0.05 was considered significant.Biomechanical testing was used to verify the tibial stresses.Compared to the original group(OG),the TO group(TOG)exhibited lower stress on the stem,and the maximum von Mises stresses were 87.2 and 53.1 MPa,respectively,a 39.1%reduction(p<0.05).Conversely,the stress and strain energy on the tibia increased in the TOG.The maximum von Mises stress values were 16.4 MPa in the OG and 22.9 MPa in the TOG with a 39.6%increase(p<0.05),and the maximum SED value was 0.026 MPa in the OG and 0.042 MPa in the TOG,corresponding to an increase of 61.5%(p<0.05).The maximum micromotions in the distal end of the stem were 135μm in the OG and 68μm in the TOG,almost a 50%reduction.The stress curves of the biomechanical test coincided well with the FEA results.The TO approach can effectively reduce the whole weight of the prosthesis and improve the biomechanical environment of the tibia.It could also pave the way for next-generation applications in orthopedics surgery.展开更多
Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young ch...Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young children remains a difficult and expensive challenge in our context. The delay in care and the lack of social security for all, are risk factors for morbidity. The induced membrane technique described by Masquelet starts to be applied and showed satisfactory results. We report the results of a case of reconstruction of the proximal humerus by using a non-vascularized fibula and supplemental bone substitute in a boy of 2 years with sickle cell. No scarring occurred at the sampling site. The process of bone consolidation is underway.展开更多
BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with min...BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.展开更多
文摘BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.
基金National Natural Science Foundation of China[Grant Numbers 81802174,81900726&82072456]Department of Science and Technology of Jilin Province,P.R.C[Grant Numbers 20200404202YY,20200403086SF&20200201453JC]+8 种基金Jilin Province Development and Reform Commission,P.R.C[Grant Number 2018C010]Education Department of Jilin Province,P.R.C[GrantNumber JJKH20180106KJ]Administration of Traditional Chinese Medicine of Jilin Province P.R.C[Grant Number 2018115]10th Youth Project of the First Hospital of Jilin University[Grant Number JDYY102019025]Department of Finance in Jilin Province[Grant Number 2019SCZT046]Undergraduate Teaching Reform Research Project of Jilin University[Grant Number 4Z2000610852]Key training plan for outstanding young teachers of Jilin University[Grant Number 419080520253]Bethune plan of Jilin University[Grant Number 470110000692]The major participant is Qing Han.
文摘A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was validated through finite element analysis(FEA)and biomechanical tests.The tibia with inhomogeneous material properties was reconstructed according to computed tomography images,and different components were designed to simulate the operation.Minimum compliance TO subject to a volume fraction constraint combined with a graded lattice structure was utilized to redesign the prosthesis.FEA was performed to evaluate the mechanical performances of the tibia and implants after optimization,including stress,micromotion,and strain energy.The results were analyzed by paired-samples t tests,and p<0.05 was considered significant.Biomechanical testing was used to verify the tibial stresses.Compared to the original group(OG),the TO group(TOG)exhibited lower stress on the stem,and the maximum von Mises stresses were 87.2 and 53.1 MPa,respectively,a 39.1%reduction(p<0.05).Conversely,the stress and strain energy on the tibia increased in the TOG.The maximum von Mises stress values were 16.4 MPa in the OG and 22.9 MPa in the TOG with a 39.6%increase(p<0.05),and the maximum SED value was 0.026 MPa in the OG and 0.042 MPa in the TOG,corresponding to an increase of 61.5%(p<0.05).The maximum micromotions in the distal end of the stem were 135μm in the OG and 68μm in the TOG,almost a 50%reduction.The stress curves of the biomechanical test coincided well with the FEA results.The TO approach can effectively reduce the whole weight of the prosthesis and improve the biomechanical environment of the tibia.It could also pave the way for next-generation applications in orthopedics surgery.
文摘Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young children remains a difficult and expensive challenge in our context. The delay in care and the lack of social security for all, are risk factors for morbidity. The induced membrane technique described by Masquelet starts to be applied and showed satisfactory results. We report the results of a case of reconstruction of the proximal humerus by using a non-vascularized fibula and supplemental bone substitute in a boy of 2 years with sickle cell. No scarring occurred at the sampling site. The process of bone consolidation is underway.
文摘BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.
