SLR - September 2022 - Christine Schuler, DPM
Reference: Rohilla R, Sharma PK, Wadhwani J, Das J, Singh R, Beniwal D. Prospective randomized comparison of bone transport versus Masquelet technique in infected gap nonunion of tibia. Arch Orthop Trauma Surg. 2022 Aug;142(8):1923-1932.Level of Evidence: Level II
Scientific Literature Review
Reviewed By: Christine Schuler DPM
Residency Program: Bethesda, Boynton Beach, FL
Podiatric Relevance: With the increase in prevalence of severe injury and resulting infection to the lower extremities, there is a concomitant increase of infected gap non-unions of the tibia in recent decades. This problem can be quite difficult to manage for surgeons, but two treatment modalities have come to the forefront to help solve this problem, the Ilizarov bone transport, and Masquelet technique. This study compares the management of infected gap non-union of the tibia in respect to union, complications, and functional outcomes in 25 patients prospectively.
Methods: A level II prospective randomized study compared patients with infected gap non-union of the tibia with bone gap up to 6 cm, who received treatment via the Ilizarov or Masquelet technique. A total of 25 patients were randomized into either Ilizarov (group I, 13 patients), or Masquelet (group II, 12 patients), no statistically significant difference was found between these groups. A monolateral fixator was applied in nine patients each in both groups, while four in group I and three fractures in group II were stabilized with ring fixators. Bone and functional results were compared using the association for the study and application of the method of Ilizarov (ASAMI) criteria.
Results: The study shows statistically significant decrease in the average fixator period with Ilizarov at 9.42 moths and Masquelet at 16.33 months (p<0.001). As well as a decrease in residual limp which was present in three patients (23.07 percent) in Ilizarov and nine patients (75 percent) in Masquelet (p 0.028). Functional and bony results were statistically insignificant between the groups, while Ilizarov represented better results than Masquelet. With one non-union in the Ilizarov and six reported in the Masquelet groups. Similarly, excellent functional outcome were more common in Ilizarov (eight patients, 61.5 percent) than in Masquelet (two patients, 16.6 percent), (p 0.06).
Conclusions: There is no statistically significant difference between Ilizarov and Masquelet technique in terms of bony or functional results, however there is a decrease in fixator time and decrease in the prevalence of a residual limp with the Ilizarov technique. The study also points toward an increase in union and patient functional outcomes with the Ilizarov, althought it was not significant There were several limitations to this study in term of size and follow up time. However, the strength of study is its prospective and randomized nature, which is a good start to help fill the gap in English medical literature about comparing the two techniques in treatment of infected non-union of the tibia. Both Ilizarov bone transport and Masquelet technique achieved comparable radiological and functional outcomes in infected gap nonunion of the tibia with bone loss up to 6 cm, but the results favored the Ilizarov bone transport technique, with statistically significant decrease in external fixation time and decrease in residual limp. Authors suggest Ilizarov being more reliable, however further studies are needed to further support this statement.