Distraction osteogenesis in the treatment of long bone defects of the lower limbs

Author:

Papakostidis C.1,Bhandari M.2,Giannoudis P. V.3

Affiliation:

1. “G. Hatzikostas” General Hospital, Department of Trauma and Orthopaedics, Makriyianni Av., 45 001, Ioannina, Greece.

2. McMaster University, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada.

3. Leeds University School of Medicine, Academic Department of Trauma and Orthopaedics, Leeds Biomedical Research Unit, Leeds General Infirmary, Clarendon Wing Level A, Great George Street, Leeds LS1 3EX, UK.

Abstract

We carried out a systematic review of the literature to evaluate the evidence regarding the clinical results of the Ilizarov method in the treatment of long bone defects of the lower limbs. Only 37 reports (three non-randomised comparative studies, one prospective study and 33 case-series) met our inclusion criteria. Although several studies were unsatisfactory in terms of statistical heterogeneity, our analysis appears to show that the Ilizarov method of distraction osteogenesis significantly reduced the risk of deep infection in infected osseous lesions (risk ratio 0.14 (95% confidence interval (CI) 0.10 to 0.20), p < 0.001). However, there was a rate of re-fracture of 5% (95% CI 3 to 7), with a rate of neurovascular complications of 2.2% (95% CI 0.3 to 4) and an amputation rate of 2.9% (95% CI 1.4 to 4.4).The data was generally not statistically heterogeneous. Where tibial defects were > 8 cm, the risk of re-fracture increased (odds ratio 3.7 (95% CI 1.1 to 12.5), p = 0.036). The technique is demanding for patients, illustrated by the voluntary amputation rate of 1.6% (95% CI 0 to 3.1), which underlines the need for careful patient selection. Cite this article: Bone Joint J 2013;95-B:1673–80.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

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