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Septic Tibial Nonunions on Proximal and Distal Metaphysis—A Systematic Narrative Review
Background: Infected nonunion of the tibia represents a challenging complication for orthopedic surgeons and poses a major financial burden to healthcare systems. The situation is even more compounded when the nonunion involves the metaphyseal region of long bones, a rare yet demanding complication...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10296242/ https://www.ncbi.nlm.nih.gov/pubmed/37371760 http://dx.doi.org/10.3390/biomedicines11061665 |
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author | Sidiropoulos, Konstantinos Panagopoulos, Andreas Tsikopoulos, Konstantinos Saridis, Alkis Assimakopoulos, Stelios F. Kouzelis, Antonis Vrachnis, Ioannis N. Givissis, Panagiotis |
author_facet | Sidiropoulos, Konstantinos Panagopoulos, Andreas Tsikopoulos, Konstantinos Saridis, Alkis Assimakopoulos, Stelios F. Kouzelis, Antonis Vrachnis, Ioannis N. Givissis, Panagiotis |
author_sort | Sidiropoulos, Konstantinos |
collection | PubMed |
description | Background: Infected nonunion of the tibia represents a challenging complication for orthopedic surgeons and poses a major financial burden to healthcare systems. The situation is even more compounded when the nonunion involves the metaphyseal region of long bones, a rare yet demanding complication due to the poor healing potential of infected cancellous bone; this is in addition to the increased likelihood of contamination of adjacent joints. The purpose of this study was to determine the extent and level of evidence in relation to (1) available treatment options for the management of septic tibial metaphyseal nonunions; (2) success rates and bone healing following treatment application; and (3) functional results after intervention. Methods: We searched the MEDLINE, Embase, and CENTRAL databases for prospective and retrospective studies through to 25 January 2021. Human-only studies exploring the efficacy of various treatment options and their results in the setting of septic, quiescent, and metaphyseal (distal or proximal) tibia nonunions in the adult population were included. For infection diagnosis, we accepted definitions provided by the authors of source studies. Of note, clinical heterogeneity rendered data pooling inappropriate. Results: In terms of the species implicated in septic tibial nonunions, staphylococcus aureus was found to be the most commonly isolated microorganism. Many authors implemented the Ilizarov external fixation device with a mean duration of treatment greater than one year. Exceptional or good bone and functional results were recorded in over 80% of patients, although the literature is scarce and possible losses of the follow-up were not recorded. Conclusion: A demanding orthopedic condition that is scarcely studied is infected metaphyseal tibial nonunion. External fixation seems promising, but further research is needed. Systematic Review Registration: PROSPERO No. CRD42020205781. |
format | Online Article Text |
id | pubmed-10296242 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-102962422023-06-28 Septic Tibial Nonunions on Proximal and Distal Metaphysis—A Systematic Narrative Review Sidiropoulos, Konstantinos Panagopoulos, Andreas Tsikopoulos, Konstantinos Saridis, Alkis Assimakopoulos, Stelios F. Kouzelis, Antonis Vrachnis, Ioannis N. Givissis, Panagiotis Biomedicines Systematic Review Background: Infected nonunion of the tibia represents a challenging complication for orthopedic surgeons and poses a major financial burden to healthcare systems. The situation is even more compounded when the nonunion involves the metaphyseal region of long bones, a rare yet demanding complication due to the poor healing potential of infected cancellous bone; this is in addition to the increased likelihood of contamination of adjacent joints. The purpose of this study was to determine the extent and level of evidence in relation to (1) available treatment options for the management of septic tibial metaphyseal nonunions; (2) success rates and bone healing following treatment application; and (3) functional results after intervention. Methods: We searched the MEDLINE, Embase, and CENTRAL databases for prospective and retrospective studies through to 25 January 2021. Human-only studies exploring the efficacy of various treatment options and their results in the setting of septic, quiescent, and metaphyseal (distal or proximal) tibia nonunions in the adult population were included. For infection diagnosis, we accepted definitions provided by the authors of source studies. Of note, clinical heterogeneity rendered data pooling inappropriate. Results: In terms of the species implicated in septic tibial nonunions, staphylococcus aureus was found to be the most commonly isolated microorganism. Many authors implemented the Ilizarov external fixation device with a mean duration of treatment greater than one year. Exceptional or good bone and functional results were recorded in over 80% of patients, although the literature is scarce and possible losses of the follow-up were not recorded. Conclusion: A demanding orthopedic condition that is scarcely studied is infected metaphyseal tibial nonunion. External fixation seems promising, but further research is needed. Systematic Review Registration: PROSPERO No. CRD42020205781. MDPI 2023-06-08 /pmc/articles/PMC10296242/ /pubmed/37371760 http://dx.doi.org/10.3390/biomedicines11061665 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Systematic Review Sidiropoulos, Konstantinos Panagopoulos, Andreas Tsikopoulos, Konstantinos Saridis, Alkis Assimakopoulos, Stelios F. Kouzelis, Antonis Vrachnis, Ioannis N. Givissis, Panagiotis Septic Tibial Nonunions on Proximal and Distal Metaphysis—A Systematic Narrative Review |
title | Septic Tibial Nonunions on Proximal and Distal Metaphysis—A Systematic Narrative Review |
title_full | Septic Tibial Nonunions on Proximal and Distal Metaphysis—A Systematic Narrative Review |
title_fullStr | Septic Tibial Nonunions on Proximal and Distal Metaphysis—A Systematic Narrative Review |
title_full_unstemmed | Septic Tibial Nonunions on Proximal and Distal Metaphysis—A Systematic Narrative Review |
title_short | Septic Tibial Nonunions on Proximal and Distal Metaphysis—A Systematic Narrative Review |
title_sort | septic tibial nonunions on proximal and distal metaphysis—a systematic narrative review |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10296242/ https://www.ncbi.nlm.nih.gov/pubmed/37371760 http://dx.doi.org/10.3390/biomedicines11061665 |
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