AI Article Synopsis
- The study aimed to compare the quality of consolidated bone in the anteromedial aspect of regenerated bone (AMRB) versus other areas (TORB) after using the induced membrane technique (IMT) for critical tibial shaft defects.
- Results showed that AMRB experienced more negative changes in bone volume and density, and a lower rate of corticalization compared to TORB over a year, indicating poorer consolidation quality.
- Factors identified that negatively affected consolidation in the AMRB include fracture-related infections, age, and defect length, which suggest that these variables should be considered in patient management and treatment outcomes.
Article Abstract
Objectives: To compare the consolidation quality between the anteromedial aspect of regenerated bone (AMRB) and the other areas of regenerated bone (TORB) following the induced membrane technique (IMT) for managing critical-sized tibial shaft bone defects, and determine the factors affecting consolidation quality in the AMRB.
Design: Retrospective comparative study.
Setting: Academic Level I trauma center.
Patients Selection Criteria: Included were patients who underwent IMT with only an intramedullary nail for tibial shaft segmental defects and serial computed tomography immediately, 6 months, and 1 year postoperatively.
Outcome Measures And Comparisons: Comparison were made of regenerative bone volume, density, and corticalization between AMRB and TORB.
Results: This study enrolled 37 patients with a mean age of 47.7 years (range 20-79). Twenty-eight (75.7%) patients were men. Postoperatively, the AMRB exhibited significantly more negative volumetric change than TORB at 0-1 year (-20.01% ± 25.59% vs. -13.32% ± 22.48%, P = 0.028), less positive density change 0-6 months (+197.84 ± 107.95 vs. +290.14 ± 131.74 Hounsfield unit (HU), P < 0.001) and 0-1 year (+377.51 ± 150.71 HU vs. +455.48 ± 135.04 HU, P < 0.001), and lower corticalization rate in 1 year (49.77% ± 29.42% vs. 82.27 ± 19.73%, P < 0.001). Significant factors included fracture-related infection (FRI) ( P = 0.047 and P = 0.048 at 0-6 months and 0-1 year, respectively) and longer defect length ( P = 0.032 and P = 0.020) for the negative volumetric AMRB changes; older age ( P = 0.004 and P = 0.016) for the AMRB negative density changes; higher percentage of mixed recombinant human bone morphogenetic protein-2 in graft material ( P = 0.013 in 0-6 months) for the AMRB positive density change; FRI ( P = 0.024) for the inferior corticalization rate of the AMRB; FRI ( P = 0.026 in 0-1 year), longer defect length ( P = 0.017 in 0-6 months), and higher mixed demineralized bone matrix percentage ( P = 0.010 in 0-1 year) for the difference in density change between the AMRB and TORB; higher mixed demineralized bone matrix percentage ( P = 0.023) for the difference between the AMRB and TORB in corticalization rates.
Conclusions: The tibial shaft's anteromedial aspects demonstrated significantly inferior consolidation after IMT, especially in terms of volume at 6 months, density at 6 months and 1 year, and corticalization at 1 year postoperatively.
Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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| http://dx.doi.org/10.1097/BOT.0000000000002928 | DOI Listing |
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