The management of critical bone defects: outcomes of a systematic approach.
Background: The reconstruction of segmental long bone defects remains one of 'The holy grails of orthopaedics'. The optimal treatment of which remains a topic of great debate. This study aimed to evaluate the outcomes following the management of critical-sized bone defects using a classification-bas...
| Publicado en: | European Journal of Orthopaedic Surgery & Traumatology Vol. 34; no. 6; pp. 3225 - 3232 |
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| Autores principales: | , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Springer Nature
Aug2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=179460804&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 179460804 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 16338065 P4L jtl: European Journal of Orthopaedic Surgery & Traumatology issn: 16338065 maglogo: N pubinfo: dt: Aug2024 vid: 34 iid: 6 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 179460804 178759736 179460804 179460804 10.1007/s00590-024-04050-1 179460804 ppf: 3225 ppct: 7 formats: tig: atl: The management of critical bone defects: outcomes of a systematic approach. aug: au: Tsang, Shao-Ting Jerry van Rensburg, Adrian Jansen van Heerden, Jason Epstein, Gadi Zwe Venter, Rudolph Ferreira, Nando affil: https://ror.org/05bk57929 Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, 7505, Cape Town, South Africa sug: subj: Bone Transplantation Methods Fractures, Open Surgery Fracture Fixation Methods Algorithms Tibial Fractures Surgery Treatment Outcomes Human Male Female Young Adult Adult Middle Age Retrospective Design Prospective Studies Fracture Healing Orthopedic Surgery Sepsis Risk Factors Risk Assessment Descriptive Statistics Confidence Intervals Surgery, Reconstructive Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background: The reconstruction of segmental long bone defects remains one of 'The holy grails of orthopaedics'. The optimal treatment of which remains a topic of great debate. This study aimed to evaluate the outcomes following the management of critical-sized bone defects using a classification-based treatment algorithm. Methods: A retrospective review of all patients undergoing treatment for segmental diaphyseal defects of long bones at a tertiary-level limb reconstruction unit between January 2016 and December 2021, was performed. The management of the bone defect was standardised as per the classification by Ferreira and Tanwar (2020). Results: A total of 96 patients (mean age 39.8, SD 15.2) with a minimum six months follow-up were included. Most bone defects were the result of open fractures (75/96) with 67% associated with Gustilo-Anderson IIIB injuries. There was a statistical difference in the likelihood of union between treatment strategies with more than 90% of cases undergoing acute shortening and bone transport achieving union and only 72% of cases undergoing the induced membrane technique consolidating (p = 0.049). Of those defects that consolidated, there was no difference in the time to bone union between strategies (p = 0.308) with an overall median time to union 8.33 months (95% CI 7.4 – 9.2 months). The induced membrane technique was associated with a 40% risk of sepsis. Conclusion: This study reported the outcomes of a standardised approach to the management of critical-sized bone defects. Whilst overall results were supportive of this approach, the outcomes associated with the induced membrane technique require further refinement of its indications in the management of critical-sized bone defects. Level of evidence: 4. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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