Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jan 16:2021:6668617.
doi: 10.1155/2021/6668617. eCollection 2021.

A Systematic Review and Meta-Analysis of Combined Antibiotic Spacer with Ilizarov Methods in the Treatment of Infected Nonunion of Tibia

Zhibo Deng  1 , Yuexi Mu  1 , Xianding Sun  1 , Yongqing Xu  2 , Fubing Li  2 , Liangjun Yin  1
Affiliations
Meta-Analysis

A Systematic Review and Meta-Analysis of Combined Antibiotic Spacer with Ilizarov Methods in the Treatment of Infected Nonunion of Tibia

Zhibo Deng et al. Biomed Res Int. .

Abstract

Background: The objective of this systematic review was to evaluate current studies available reporting the antibiotic spacer combined with Ilizarov methods in the treatment of infected nonunion of tibia and to perform meta-analysis of bone results and infection recurrence to assess the efficacy of an antibiotic spacer combined with Ilizarov methods.

Methods: The MEDLINE, Embase, Cochrane Library, CNKI, and CBM (Chinese Biological Medicine) databases were searched for articles published between January 2000 and July 2020. Assessment of study quality was performed using a modified version of the Newcastle-Ottawa scale. Effect size and 95% confidence intervals were calculated for the main outcome. Heterogeneity was assessed. Fixed-effect modeling and Stata version 15.1 were used to analyze the data. Sensitivity analyses were conducted with the evidence of heterogeneity.

Results: 11 studies involving 210 patients with infected nonunion of tibia were finally included in our meta-analysis. Bone results and infection recurrence were analyzed based on the single-arm meta-analysis. The average of external fixation index (EFI) was 46.88 days/cm in all studies included. The excellent rate in bone results and the rate of infection recurrence was 65% (95% CI: [0.22, 0.97], I 2 = 0.0%, P = 0.932) and 6.99% (95% CI: [0.052, 0.325], I 2 = 0.0%, P = 1.000) in patients with infected nonunion of tibia treated with an antibiotic spacer combined with Ilizarov methods.

Conclusions: Our meta-analysis revealed that the patients with infected nonunion of tibia treated with an antibiotic spacer combined with Ilizarov methods had a high rate of excellent bone results and a low rate of infection recurrence. Therefore, combining the antibiotic spacer with Ilizarov methods may be an applicable choice for repairing and reconstructing infected nonunion of tibia.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
The flow chart of literature screening.
Figure 2
Figure 2
Forest plot showing excellent rate of bone results. According to the formula (P = (sin(x/2))2), the final rate was equal to 0.65; 95% CI ranged from 0.22 to 0.97.
Figure 3
Figure 3
Forest plot showing rate of infection recurrence. According to the formula (P = (sin(x/2))2), the final rate was equal to 0.0699, 95% CI ranged from 0.0518 to 0.325.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Rohilla R., Wadhwani J., Devgan A., Singh R., Khanna M. Prospective randomised comparison of ring versus rail fixator in infected gap nonunion of tibia treated with distraction osteogenesis. The bone & joint journal. 2016;98-B(10):1399–1405. doi: 10.1302/0301-620x.98b10.37946. - DOI - PubMed
    1. Motsitsi N. S. Management of infected nonunion of long bones: the last decade (1996-2006) Injury. 2008;39(2):155–160. doi: 10.1016/j.injury.2007.08.032. - DOI - PubMed
    1. Rohilla R., Sharma P. K., Wadhwani J., et al. Prospective randomized comparison of quality of regenerate in distraction osteogenesis of ring versus monolateral fixator in patients with infected nonunion of the tibia using digital radiographs and ct. The bone & joint journal. 2019;101:1416–1422. doi: 10.1302/0301-620x.101b11.Bjj-2019-0189.R1. - DOI - PubMed
    1. Cierny G., 3rd, Zorn K. E. Segmental tibial defects. Comparing conventional and Ilizarov methodologies. Clinical orthopaedics and related research. 1994;301:118–123. - PubMed
    1. Zaidenberg E. E., Martinez E., Zaidenberg C. R. Vascularized distal radius bone graft for treatment of ulnar nonunion. The Journal of Hand Surgery. 2018;43:685.e1–685.e5. doi: 10.1016/j.jhsa.2018.03.005. - DOI - PubMed

LinkOut - more resources