{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:53:21Z","timestamp":1792461201633,"version":"4.5.0"},"reference-count":53,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>We present a treatment algorithm comprising 4 Ilizarov methods in managing infected tibial nonunion, using nonunion mobility and segmental defect size to govern treatment choice.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Decision protocol analysis study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>A university-affiliated teaching hospital.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients\/Participants:<\/jats:title>\n            <jats:p>Seventy-nine patients were treated with 1 of 4 Ilizarov protocols. All patients had undergone at least one previous operation, 38 had associated limb deformity, and 49 had nonviable nonunions. Twenty-six had a new muscle flap at the time of Ilizarov surgery, and 25 had preexisting flaps reused.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>Twenty-six cases were treated with monofocal distraction, 19 with monofocal compression, 16 with bifocal compression\/distraction, and 18 with bone transport.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measurements:<\/jats:title>\n            <jats:p>The primary outcome measure was the absence of recurrent infection. Secondary outcomes included bone union, complications, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, and any need for further unplanned surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Infection was eradicated in 76 cases (96.2%) with a mean follow-up duration of 40.8 months (range 6\u2013131). All 3 infection recurrences occurred in the monofocal compression group. Following the initial Ilizarov method alone, union was achieved in 68 cases (86.1%) and was highest among the monofocal distraction (96.2%) and bifocal compression\/distraction groups (93.8%). Monofocal compression achieved the lowest union rate (73.7%), significantly lower ASAMI scores, and a refracture rate of 31.6%. Bone transport secured union in 77.8% with a 44.4% unplanned reoperation rate. However, infection-free union was 100% after further treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Monofocal compression is not recommended for treating infected, mobile nonunions. Distraction (monofocal or bifocal) was effective and achieved higher rates of union and infection clearance.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Level III.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000000987","type":"journal-article","created":{"date-parts":[[2017,9,25]],"date-time":"2017-09-25T08:23:22Z","timestamp":1506327802000},"page":"S47-S54","source":"Crossref","is-referenced-by-count":90,"title":["Ilizarov Treatment Protocols in the Management of Infected Nonunion of the Tibia"],"prefix":"10.1097","volume":"31","author":[{"given":"Martin","family":"McNally","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Ferguson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Kugan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Stubbs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230828","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/01.blo.0000152868.29134.92","article-title":"Infected nonunion of the long bones","volume":"431","author":"Jain","year":"2005","journal-title":"Clin Orthop Relat Res."},{"key":"R2-20230828","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1302\/0301-620X.97B6.33276","article-title":"Management of infected nonunion of the long bones by a multidisciplinary team","volume":"97-B","author":"Bose","year":"2015","journal-title":"Bone Joint J."},{"key":"R3-20230828","article-title":"Infection after fracture fixation: current surgical and microbiological concepts","author":"Metsemakers","year":"2016","journal-title":"Injury"},{"key":"R4-20230828","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1097\/00005373-199906000-00012","article-title":"Aggressive treatment of 119 open fracture wounds","volume":"46","author":"DeLong","year":"1999","journal-title":"J Trauma Acute Care Surg."},{"key":"R5-20230828","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1302\/0301-620X.86B4.14097","article-title":"Factors affecting rates of infection and nonunion in intramedullary nailing","volume":"86","author":"Malik","year":"2004","journal-title":"J Bone Joint Surg Br."},{"key":"R6-20230828","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1097\/00005131-200208000-00006","article-title":"The effect of time to definitive treatment on the rate of nonunion and infection in open fractures","volume":"16","author":"Harley","year":"2002","journal-title":"J Orthop Trauma."},{"key":"R7-20230828","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/01.blo.0000163836.66906.74","article-title":"Path analysis of factors for delayed healing and nonunion in 416 operatively treated tibial shaft fractures","volume":"438","author":"Audig\u00e9","year":"2005","journal-title":"Clin Orthop Relat Res."},{"key":"R8-20230828","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1471-2474-14-42","article-title":"Tibia shaft fractures: costly burden of nonunions","volume":"14","author":"Antonova","year":"2013","journal-title":"BMC Musculoskelet Disord."},{"key":"R9-20230828","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jcot.2015.04.004","article-title":"Surgical site infection in orthopedic trauma: a case\u2013control study evaluating risk factors and cost","volume":"6","author":"Thakore","year":"2015","journal-title":"J Clin Orthop Trauma."},{"key":"R10-20230828","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jhin.2006.01.015","article-title":"Deep wound infection after proximal femoral fracture: consequences and costs","volume":"63","author":"Pollard","year":"2006","journal-title":"J Hosp Infect."},{"key":"R11-20230828","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.mporth.2010.09.004","article-title":"Osteomyelitis","volume":"24","author":"McNally","year":"2010","journal-title":"Orthop Trauma."},{"key":"R12-20230828","doi-asserted-by":"crossref","first-page":"e0141973","DOI":"10.1371\/journal.pone.0141973","article-title":"A systematic 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."},{"key":"R13-20230828","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/00003086-198901000-00038","article-title":"The tension-stress effect on the genesis and growth of tissues: Part I. 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