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Meta-Analysis
. 2024 Jun;50(3):705-721.
doi: 10.1007/s00068-023-02375-w. Epub 2023 Nov 3.

Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies

Sophia M Wakefield  1 , Costas Papakostidis  1 , Vasileios P Giannoudis  1 , Alfonso Mandía-Martínez  1 , Peter V Giannoudis  2   3
Affiliations
Meta-Analysis

Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies

Sophia M Wakefield et al. Eur J Trauma Emerg Surg. 2024 Jun.

Abstract

Introduction: Infected tibial non-unions with associated bone loss can be challenging to manage. At present, the two main methods utilized in the management of these fractures include the Ilizarov technique of Distraction Osteogenesis (DO) using external fixator devices, or alternatively, the Induced Membrane Technique (IMT), devised by Masquelet. As there is a paucity of data directly comparing the outcomes of these techniques, there is no universal agreement on which strategy a surgeon should choose to use.

Aims: This systematic review and meta-analysis aimed to summarize the outcomes of both DO and IMT, in terms of primary outcomes (bone union and infection elimination), and secondary outcomes (complication rates and functional outcomes).

Methods: A PRISMA strategy was used. Medline, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated using OCEBM and GRADE systems.

Results: Thirty-two studies with 1136 subjects met the inclusion criteria. With respect to the primary outcomes of interest, union was observed in 94.6% (DO method) and 88.0% (IMT method); this difference, however, was not significant between the two techniques (p = 0.45). In addition, infection elimination rates were also higher in the Ilizarov DO group when compared to Masquelet (Mq) IMT (93.0% vs 80.4% respectively). Again, no significant difference was observed (p = 0.06). For all secondary outcomes assessed (unplanned re-operations, re-fracture rates amputation rate), no statistically significant differences were documented between the treatment options.

Conclusion: This study demonstrated that there is no clinical difference in outcomes for patients treated with Ilizarov DO versus Mq IMT techniques. The evidence base at present is relatively sparse and, therefore, we would recommend for further Level I studies to be conducted, to make more meaningful conclusions.

Keywords: Bone defect; Distraction osteogenesis; Induced membrane technique; Infection; Masquelet; Non-union; Tibia.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflict of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart
Fig. 2
Fig. 2
Funnel plots demonstrating union rates and infection elimination rates between the Ilizarov and Masquelet groups
Fig. 3
Fig. 3
Boxplots of a union rate and, b the infection elimination rate between the Ilizarov and Masquelet groups
See this image and copyright information in PMC

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References

    1. Struijs PA, Poolman RW, Bhandari M. Infected nonunion of the long bones. J Orthop Trauma. 2007;21:507–511. doi: 10.1097/BOT.0b013e31812e5578. - DOI - PubMed
    1. Jain AK, Sinha S. Infected nonunion of the long bones. Clin Orthop Relat Res. 2005;431:57–65. doi: 10.1097/01.blo.0000152868.29134.92. - DOI - PubMed
    1. Papakostidis C, Giannoudis PV. Reconstruction of infected long bone defects: issues and challenges. Injury. 2023;54:807–810. doi: 10.1016/j.injury.2023.01.052. - DOI - PubMed
    1. Ilizarov GA, Ledyaev VI. The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments. 1969. Clin Orthop. 1992;280:7–10. doi: 10.1097/00003086-199207000-00002. - DOI - PubMed
    1. Malkova TA, Borzunov DY. International recognition of the Ilizarov bone reconstruction techniques: current practice and research (dedicated to 100(th) birthday of G. A. Ilizarov) World J Orthop. 2021;12:515–533. doi: 10.5312/wjo.v12.i8.515. - DOI - PMC - PubMed