Prospective randomized comparison of bone transport versus Masquelet technique in infected gap nonunion of tibia.

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Abstract

[Indexed for MEDLINE] 7. BMC Musculoskelet Disord. 2018 Dec 13;19(1):442. doi: 10.1186/s12891-018-2363-5. Infection-free rates and Sequelae predict factors in bone transportation for infected tibia: a systematic review and meta-analysis. Zhang Z(1)(2), Swanson WB(2), Wang YH(3), Lin W(4), Wang G(5). Author information: (1)Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China. (2)Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, USA. (3)Department of Neonatology, Beijing Gynecology & Obstetrics Hospital, Capital Medical University, Beijing, China. (4)Department of Gynecology, West China Second Hospital, Sichuan University, Chengdu, China. (5)Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China. wangglfrank@hotmail.com. BACKGROUND: Tibia infected nonunion and chronic osteomyelitis are challenging clinical presentations. Bone transportation with external or hybrid fixators (combined external and internal fixators) is versatile to solve these problems. However, the infection-free rates of these fixator systems are unknown. Additionally, the prognosis factors for results of bone transportation are obscure. Therefore, this systematic review and meta-analysis was conducted to answer these questions. METHODS: A systematic review was conducted following the PRISMA-IPD guidelines. Relevant publications from January 1995 to September 2018 were compiled from Medline, Embase, and Cochrane. The infection-free rates of external and hybrid fixators were achieved by synthesizing aggregate data and individual participant data (IPD). IPD was analyzed by two-stage method with logistical regression to identify prognosis factors of sequelae. RESULTS: Twenty-two studies with 518 patients were identified, including 11 studies with 167 patients' IPD, and 11 studies with 351 patients' aggregate data. The infection-free rate of hybrid fixator group was 86% (95%CI: 79-94%), lower than that of external fixator which was 97% (95%CI: 95-98%,). The number of previous surgeries was found predict factor of bone union sequelae (p = 0.04) and function sequelae(p