Authored by Mohammed Anter Meselhy*
Abstract
Objectives: The aim of this work is to systematically review and make meta-analysis for treatment of the infected non-union of the tibia.
Methodology: A systematic review was completed, Study objective and comprehensive literature search were performed from the SCI, PubMed, Cochrane Library; and Embase between January 2000 and Feb. 2019. Some major data were statistically analyzed including number of patients, manage, external fixation time, Searches will be performed in the MEDLINE, Life Science Citations, PubMed, Google Scholar and EMBASE Biochemical (http://www.embase.com) databases will be accessed to search studies with no limits set during research, Terms aimed at capturing the target diagnosis, such as “infected tibial nonunion” and “fixation” were combined using the Boolean operator “or” and MeSH terms.
Result: 318 abstracts were identified during the search, 10 were excluded, 308 full articles were fully reviewed, 295 articles were excluded, 13 studied matched the inclusion criteria and were included in this review, 2 additional articles were identified during searching, a total 652 patients of 15 studies were presented in this systemic review.
Conclusion: Radical debridment of the infected non-union is mandatory, a satisfactory bone results and functional results were obtained. On the other hand Ilizaov technique proved as the most useful method in the treatment of the infected non-union of the tibia.
Keywords: Tibial; Nonunion; Infected; Ilizarov
Introduction
Tibial shaft non-union is considered the commonest type of long bone non-union, the aetiological factors are due to high incidence of severe open fractures, high energy trauma associated with vascular and soft tissue compromise, infection and bone devitalization and segmental bone loss [1-5]. In this review, analysis of the different methods for the treatment of the infected non-union of the tibia and the results to find the most successful technique with a satisfactory outcome.
Subjects and Methods
Study objective and comprehensive literature search were performed from the SCI, PubMed, Cochrane Library and Embase between January 2000 and Feb 2019. Some major data were statistically analyzed, including number of patients, manage, external fixation time, Searches will be performed in the MEDLINE, Life Science Citations, PubMed, Google Scholar and EMBASE Biochemical (http://www.embase.com/) databases will be accessed to search studies with no limits set during research, Terms aimed at capturing the target diagnosis, such as “infected tibial nonunion” and “fixation” were combined using the Boolean operator “or” and MeSH terms.
Selection criteria
1) Prospective or retrospective studies discussing treatment of infected Tibial nonunion.
2) Journal articles, studies and papers are all involved.
3) Clinical studies within last 18 years.
Exclusion criteria
i. Non-human studies and case reports.
ii. Cadaveric studies.
iii. Reviews, Commentaries and general discussion papers not presenting data on impacts.
Statistical analysis
The collected data will be presented as suitable tables and illustrated as suitable figures. Analysis of data will be with the aid of software package of SPSS using suitable statistical tests. For all studies, patient selection, study inclusion and exclusion criteria, patient characteristics, procedure, protocol and outcomes measured were extracted using standardized data extraction forms. Outcomes were also extracted from each study. During data extraction, each included study was assessed for quality using the Cochrane Risk of Bias Checklist.
Results
318 abstracts were identified during the search, 10 were excluded, 308 full articles were fully reviewed, 295 articles were excluded, 13 studied matched the inclusion criteria and were included in this review, 2 additional articles were identified during searching [6-20], a total 652 patients of 15 studies were presented in this systemic review (Table 1).
1) The studies included are retrospective and prospective, Outcome measures were reported in most of the studies according to ASAMI score. This includes mainly bone results and functional outcome. Some papers reported further data.
2) Study designs, study period and outcome measures are shown in (Table 2).
Regarding the type of bacteria causing the bone infection was not mentioned in studies [7-9,11,13,15,18]. While Madhusudhan TR, et al. [12] reported mixed bacterial growth (Table 3). Associated comorbidities were not mentioned in the majority of studies (Table 4). Only Bakhsh K, et al. [6] reported Smoking, Diabetes, malnourishment and obesity as associated comorbidities.
Bone results and functional results
I. The criteria are commended by ASAMI were adopted to evaluate bone results and functional results in the studies [6,7,10,12,14-17,19,20]. Bone results were evaluated by 4 criteria: union, infection, deformity and limb-length discrepancy.
II. Functional results were evaluated by 5 criteria: active, limp, minimum stiffness (knee or ankle joint), reflex sympathetic dystrophy and pain.
III. Bone results were evaluated in12 studies by ASAMI [6,7,10,12,14-17,19,20] Random effects meta-analysis showed that the weighted frequency of excellent rate, good rate, fair rate and poor rate in bone results were listed in (Tables 5,6,7).
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