{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T03:50:49Z","timestamp":1793245849350,"version":"4.5.0"},"reference-count":56,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journal-cot.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Orthopaedics and Trauma"],"published-print":{"date-parts":[[2023,5]]},"DOI":"10.1016\/j.jcot.2023.102170","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T12:04:35Z","timestamp":1684411475000},"page":"102170","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":9,"special_numbering":"C","title":["Outcome analysis of ilizarov and monorail fixators in the treatment of nonunion of long bones: A systematic review and proportion meta-analysis"],"prefix":"10.1016","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8631-6334","authenticated-orcid":false,"given":"Vikas","family":"Maheshwari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balgovind S.","family":"Raja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-5573","authenticated-orcid":false,"given":"Bom","family":"Bahadur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9182-4851","authenticated-orcid":false,"given":"Anil","family":"Regmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6798-9173","authenticated-orcid":false,"given":"Mohit","family":"Dhingra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya K.S.","family":"Gowda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jcot.2023.102170_bib1","doi-asserted-by":"crossref","DOI":"10.1016\/j.injury.2020.11.029","article-title":"Fracture nonunion in long bones: a literature review of risk factors and surgical management","volume":"52","author":"Nicholson","year":"2021","journal-title":"Injury"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5704\/MOJ.1907.001","article-title":"Fracture non-union: a review of clinical challenges and future research needs","volume":"13","author":"Stewart","year":"2019","journal-title":"Malays Orthop J"},{"issue":"12","key":"10.1016\/j.jcot.2023.102170_bib3","doi-asserted-by":"crossref","first-page":"2845","DOI":"10.3390\/ijerph15122845","article-title":"Incidence, costs and predictors of non-union, delayed union and mal-union following long bone fracture","volume":"15","author":"Ekegren","year":"2018","journal-title":"Int J Environ Res Publ Health"},{"issue":"1","key":"10.1016\/j.jcot.2023.102170_bib4","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s13018-015-0189-5","article-title":"Infected nonunion of tibia and femur treated by bone transport","volume":"10","author":"Yin","year":"2015","journal-title":"J\u00a0Orthop Surg"},{"issue":"1","key":"10.1016\/j.jcot.2023.102170_bib5","doi-asserted-by":"crossref","first-page":"29+","DOI":"10.29337\/ijops.34","article-title":"Debridement technique and dead space management for infected non-union of the tibia","volume":"2","author":"El-Rosasy","year":"2019","journal-title":"Int J Orthoplast Surg"},{"key":"10.1016\/j.jcot.2023.102170_bib6","series-title":"Prospective Analysis of Outcome in the Management of Post Traumatic Bone Defects in Tibia by Masquelet Technique","author":"Gowtham Ram","year":"2019"},{"issue":"10","key":"10.1016\/j.jcot.2023.102170_bib7","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1302\/0301-620X.98B10.37946","article-title":"Prospective randomised comparison of ring versus rail fixator in infected gap nonunion of tibia treated with distraction osteogenesis","volume":"98-B","author":"Rohilla","year":"2016","journal-title":"Bone Jt J"},{"issue":"6","key":"10.1016\/j.jcot.2023.102170_bib8","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.cjtee.2015.08.006","article-title":"Comparative study of the results of compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators","volume":"18","author":"Pal","year":"2015","journal-title":"Chin J Traumatol"},{"issue":"11","key":"10.1016\/j.jcot.2023.102170_bib9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0141973","article-title":"A\u00a0systematic review and meta-analysis of ilizarov methods in the treatment of infected nonunion of tibia and femur","volume":"10","author":"Yin","year":"2015","journal-title":"PLoS One"},{"issue":"4","key":"10.1016\/j.jcot.2023.102170_bib10","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.jcot.2023.102170_bib11","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/00003086-198904000-00017","article-title":"Ilizarov treatment of tibial nonunions with bone loss","volume":"241","author":"Paley","year":"1989","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.jcot.2023.102170_bib12","doi-asserted-by":"crossref","unstructured":"Cucherat M, Boissel JP, Leizorovicz A, Haugh MC. EasyMA (1997) a program for the meta-analysis of clinical trials. Comput Methods Progr Biomed, 53(3):187\u2013190.","DOI":"10.1016\/S0169-2607(97)00016-3"},{"issue":"5","key":"10.1016\/j.jcot.2023.102170_bib13","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"20","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"issue":"10","key":"10.1016\/j.jcot.2023.102170_bib14","first-page":"2232","article-title":"An analysis of the quality of cartilage repair studies","volume":"87","author":"Jakobsen","year":"2005","journal-title":"JBJS"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib15","first-page":"279","article-title":"Comparison of ilizarov bifocal, acute shortening and relengthening with bone transport in the treatment of infected, segmental defects of the tibia","volume":"9","author":"Sigmund","year":"2020","journal-title":"J\u00a0Clin Med"},{"issue":"6","key":"10.1016\/j.jcot.2023.102170_bib16","first-page":"634","article-title":"Treatment of osteomyelitis and infected non-union of the femur by a modified Ilizarov technique: follow-up study","volume":"42","author":"Barbarossa","year":"2001","journal-title":"Croat Med J"},{"issue":"7","key":"10.1016\/j.jcot.2023.102170_bib17","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1302\/0301-620X.88B7.17639","article-title":"Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications","volume":"88","author":"Patil","year":"2006","journal-title":"J\u00a0Bone Joint Surg Br"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib18","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1177\/230949900601400307","article-title":"Modified Ilizarov technique for infected nonunion of the femur: the principle of distraction-compression osteogenesis","volume":"14","author":"Krishnan","year":"2006","journal-title":"J\u00a0Orthop Surg Hong Kong"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib19","first-page":"273","article-title":"Acute compression and lengthening by the ilizarov technique for infected nonunion of the tibia with large bone defects","volume":"14","author":"Magadum","year":"2006","journal-title":"J\u00a0Orthop Surg"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib20","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/BOT.0b013e318162ab49","article-title":"Repair of tibial nonunions and bone defects with the Taylor Spatial Frame","volume":"22","author":"Rozbruch","year":"2008","journal-title":"J\u00a0Orthop Trauma"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib21","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/BOT.0b013e3181e5e160","article-title":"Bone transport for postinfectious segmental tibial bone defects with a combined Ilizarov\/taylor spatial frame technique","volume":"25","author":"Sala","year":"2011","journal-title":"J\u00a0Orthop Trauma"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib22","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/BOT.0b013e3181678a64","article-title":"Combined single-stage osseous and soft tissue reconstruction of the tibia with the Ilizarov method and tissue transfer","volume":"22","author":"McKee","year":"2008","journal-title":"J\u00a0Orthop Trauma"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib23","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s12570-013-0235-x","article-title":"Management of infected nonunion of the femur in adults using the Ilizarov technique","volume":"5","author":"El-Sayed","year":"2014","journal-title":"Eur Orthop Traumatol"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib24","doi-asserted-by":"crossref","first-page":"129","DOI":"10.4103\/0300-1652.182076","article-title":"Treatment of complex nonunion of the shaft of the tibia using Ilizarov technique and its functional outcome","volume":"57","author":"Sahu","year":"2016","journal-title":"Niger Med J J Niger Med Assoc"},{"issue":"suppl 6","key":"10.1016\/j.jcot.2023.102170_bib25","article-title":"Monofocal bone transport technique for bone defects greater than 5 cm in tibia: our experience in a case series of 24 patients","volume":"47","author":"Aktuglu","year":"2016","journal-title":"Injury"},{"issue":"Suppl 5","key":"10.1016\/j.jcot.2023.102170_bib26","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1097\/BOT.0000000000000987","article-title":"Ilizarov treatment protocols in the management of infected nonunion of the tibia","volume":"31","author":"McNally","year":"2017","journal-title":"J\u00a0Orthop Trauma"},{"issue":"12","key":"10.1016\/j.jcot.2023.102170_bib27","doi-asserted-by":"crossref","first-page":"2933","DOI":"10.1007\/s00264-018-3924-9","article-title":"Clinical outcomes with the corticotomy-first technique associated with the Ilizarov method for the management of the septic long bones non-union","volume":"42","author":"Hosny","year":"2018","journal-title":"Int Orthop"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib28","first-page":"213","article-title":"Management of chronic infected intra-articular fractures of the proximal tibia with ilizarov ring fixation","volume":"33","author":"Bhowmick","year":"2020","journal-title":"J\u00a0Knee Surg"},{"issue":"1","key":"10.1016\/j.jcot.2023.102170_bib29","doi-asserted-by":"crossref","first-page":"36","DOI":"10.5704\/MOJ.1903.006","article-title":"Infected non-union of tibia treated with ilizarov external fixator: our experience","volume":"13","author":"Fahad","year":"2019","journal-title":"Malays Orthop J"},{"issue":"5","key":"10.1016\/j.jcot.2023.102170_bib30","first-page":"1352","article-title":"Treatment of infected tibial non-unions with ilizarov technique: a case series","volume":"9","author":"Testa","year":"2020","journal-title":"J\u00a0Clin Med"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib31","doi-asserted-by":"crossref","first-page":"47","DOI":"10.5704\/MOJ.2007.012","article-title":"Acute shortening and Re-lengthening (ASRL) in infected non-union of tibia - advantages revisited","volume":"14","author":"Baruah","year":"2020","journal-title":"Malays Orthop J"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib33","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s00264-019-04464-1","article-title":"Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and half years follow-up","volume":"44","author":"Hosny","year":"2020","journal-title":"Int Orthop"},{"key":"10.1016\/j.jcot.2023.102170_bib34","article-title":"A\u00a0Novel technique of three-ring Ilizarov fixator frame in gap non-union of tibia","volume":"23","author":"Singh","year":"2021","journal-title":"J\u00a0Clin Orthop Trauma"},{"issue":"6","key":"10.1016\/j.jcot.2023.102170_bib35","doi-asserted-by":"crossref","first-page":"602","DOI":"10.4103\/0019-5413.121590","article-title":"Management of complex long bone nonunions using limb reconstruction system","volume":"47","author":"Seenappa","year":"2013","journal-title":"Indian J Orthop"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib36","first-page":"328","article-title":"Application of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion","volume":"33","author":"Chen","year":"2019","journal-title":"Chin J Reparative Reconstr Surg"},{"issue":"6","key":"10.1016\/j.jcot.2023.102170_bib37","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1007\/s00590-021-03082-1","article-title":"Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail","volume":"32","author":"Lu","year":"2022","journal-title":"Eur J Orthop Surg Traumatol Orthop Traumatol"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib38","first-page":"196","article-title":"Morbidity resulting from the treatment of tibial nonunion with the Ilizarov frame","volume":"45","author":"Sanders","year":"2002","journal-title":"Can J Surg J Can Chir"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib39","doi-asserted-by":"crossref","first-page":"198","DOI":"10.4103\/0019-5413.33682","article-title":"Ilizarov methodology for infected non union of the Tibia: classic circular transfixion wire assembly vs. hybrid assembly","volume":"41","author":"Baruah","year":"2007","journal-title":"Indian J Orthop"},{"issue":"7","key":"10.1016\/j.jcot.2023.102170_bib40","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.rco.2008.02.007","article-title":"Treatment of bone loss in limbs by bone transport]","volume":"94","author":"Trigui","year":"2008","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib41","first-page":"685","article-title":"Ilizarov external fixation and then nailing in management of infected nonunions of the tibial shaft","volume":"65","author":"Emara","year":"2008","journal-title":"J\u00a0Trauma"},{"issue":"3","key":"10.1016\/j.jcot.2023.102170_bib42","first-page":"426","article-title":"The treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator and a systematic review of infected tibial nonunion treated by Ilizarov methods","volume":"80","author":"Yin","year":"2014","journal-title":"Acta Orthop Belg"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib43","doi-asserted-by":"crossref","first-page":"248","DOI":"10.4055\/cios.2015.7.2.248","article-title":"Bone transport for reconstruction in benign bone tumors","volume":"7","author":"Oh","year":"2015","journal-title":"Clin Orthop Surg"},{"issue":"1","key":"10.1016\/j.jcot.2023.102170_bib44","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1186\/s13018-017-0684-y","article-title":"Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation","volume":"25;12","author":"Zhang","year":"2017","journal-title":"J\u00a0Orthop Surg"},{"issue":"8","key":"10.1016\/j.jcot.2023.102170_bib45","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1302\/0301-620X.100B8.BJJ-2017-1442.R1","article-title":"The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate","volume":"100-B","author":"Gupta","year":"2018","journal-title":"Bone Jt J"},{"issue":"Suppl 1 Pt 1","key":"10.1016\/j.jcot.2023.102170_bib46","first-page":"119","article-title":"Treatment of malunion and nonunion at the site of an ankle fusion with the Ilizarov apparatus. Surgical technique","volume":"88","author":"Paley","year":"2006","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"5","key":"10.1016\/j.jcot.2023.102170_bib47","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1007\/s00402-020-03571-8","article-title":"A\u00a0new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia","volume":"141","author":"\u0141","year":"2021","journal-title":"Arch Orthop Trauma Surg"},{"key":"10.1016\/j.jcot.2023.102170_bib48","first-page":"14","article-title":"Infected non union of tibia managed by limb reconstruction system- A prospective cohort study","volume":"1","author":"Singh Kushwaha","year":"2020","journal-title":"J\u00a0Clin Diagn Res"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib49","first-page":"149","article-title":"Current management of long bone large segmental defects","volume":"24","author":"Lasanianos","year":"2010","journal-title":"Orthop Traumatol"},{"issue":"2","key":"10.1016\/j.jcot.2023.102170_bib50","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/BOT.0000000000000700","article-title":"Treatment options for nonunion with segmental bone defects: systematic review and quantitative evidence synthesis","volume":"31","author":"Kadhim","year":"2017","journal-title":"J\u00a0Orthop Trauma"},{"key":"10.1016\/j.jcot.2023.102170_bib51","doi-asserted-by":"crossref","first-page":"S53","DOI":"10.1016\/S0020-1383(16)30840-3","article-title":"Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes","volume":"47","author":"Giannoudis","year":"2016","journal-title":"Injury"},{"issue":"6","key":"10.1016\/j.jcot.2023.102170_bib52","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/s00402-009-1014-6","article-title":"War-related infected tibial nonunion with bone and soft-tissue loss treated with bone transport using the Ilizarov method","volume":"130","author":"Bumba\u0161irevi\u0107","year":"2010","journal-title":"Arch Orthop Trauma Surg"},{"issue":"7","key":"10.1016\/j.jcot.2023.102170_bib53","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S0020-1383(00)00036-X","article-title":"The Ilizarov method in infected nonunion of fractures","volume":"31","author":"Maini","year":"2000","journal-title":"Injury"},{"issue":"1","key":"10.1016\/j.jcot.2023.102170_bib54","first-page":"22","article-title":"Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review","volume":"20","author":"Aktuglu","year":"2019","journal-title":"J\u00a0Orthop Traumatol"},{"issue":"5","key":"10.1016\/j.jcot.2023.102170_bib55","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1053\/j.jfas.2007.06.004","article-title":"Predictors of postoperative complications of ilizarov external ring fixators in the foot and ankle","volume":"46","author":"Rogers","year":"2007","journal-title":"J\u00a0Foot Ankle Surg"},{"issue":"12","key":"10.1016\/j.jcot.2023.102170_bib57","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1302\/0301-620X.95B12.32385","article-title":"Distraction osteogenesis in the treatment of long bone defects of the lower limbs","volume":"95-B","author":"Papakostidis","year":"2013","journal-title":"Bone Jt J"},{"issue":"1","key":"10.1016\/j.jcot.2023.102170_bib56","first-page":"52","article-title":"Salvage of infected non-union of the tibia with an ilizarov ring fixator","volume":"23","author":"Khan","year":"2015","journal-title":"J\u00a0Orthop Surg"}],"container-title":["Journal of Clinical Orthopaedics and Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0976566223000784?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0976566223000784?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T08:02:21Z","timestamp":1760860941000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0976566223000784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":56,"alternative-id":["S0976566223000784"],"URL":"https:\/\/doi.org\/10.1016\/j.jcot.2023.102170","relation":{},"ISSN":["0976-5662"],"issn-type":[{"value":"0976-5662","type":"print"}],"subject":[],"published":{"date-parts":[[2023,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Outcome analysis of ilizarov and monorail fixators in the treatment of nonunion of long bones: A systematic review and proportion meta-analysis","name":"articletitle","label":"Article Title"},{"value":"Journal of Clinical Orthopaedics and Trauma","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jcot.2023.102170","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2023 Delhi Orthopedic Association. All rights reserved.","name":"copyright","label":"Copyright"}],"article-number":"102170"}}