title: A Systematic Review and Meta-Analysis of Ilizarov Methods in the Treatment of Infected Nonunion of Tibia and Femur.
abstract: BACKGROUND
  Infected nonunion of tibia and femur are common in clinical practice, however, the treatment of these diseases has still been a challenge for orthopaedic surgeons. Ilizarov methods can eradicate infection, compensate bone defects and promote the bone union through progressive bone histogenesis. The objective of this systematic review was to review current available studies reporting on Ilizarov methods in the treatment of infected nonunion of tibia and femur, and to perform meta-analysis of bone and functional results and complications to evaluate the efficacy of Ilizarov methods.
  
  
  METHODS
  A comprehensive literature search was performed from the SCI, PubMed, Cochrane Library; and Embase between January 1995 and August 2015. Some major data were statistically analyzed using weighted means based on the sample size in each study by SPSS 13.0, including number of patients, mean age, mean previous surgical procedures, mean bone defects, mean length of follow-up, bone union, complications per patient, external fixation time, and external fixation index(EFI). Bone results (excellent, good, fair and poor rate), functional results (excellent, good, fair and poor rate) and complications were analyzed by Stata 9.0.
  
  
  RESULTS
  A total of 590 patients from 24 studies were included in this systematic review. The average of bone union rate was 97.26% in all included studies. The poor rate in bone results and functional results was 8% (95%CI, 0.04-0.12; I2 = 44.1%, P = 0.065) and 10% (95%CI, 0.05-0.14; I2 = 34.7%, P = 0.121) in patients with infected nonunion of tibia and femur treated by Ilizarov methods. The rate of refracture, malunion, infectious recurrence, knee stiffness, amputation, limb edema and peroneal nerve palsy was respectively 4%, 7%, 5%, 12%, 4%, 13% and 13%.
  
  
  CONCLUSIONS
  Our systematic review showed that the patients with infected nonunion of tibia and femur treated by Ilizarov methods had a low rate of poor bone and functional results. Therefore, Ilizarov methods may be a good choice for the treatment of infected nonunion of tibia and femur.
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China; School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin, 300071, P.R. China.
authors.forename: Peng
authors.initials: P
authors.lastname: Yin
authors.affiliation: School of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Qiunan
authors.initials: Q
authors.lastname: Ji
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China; School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin, 300071, P.R. China.
authors.forename: Tongtong
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
authors.forename: Jiantao
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
authors.forename: Zhirui
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
authors.forename: Jianheng
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
authors.forename: Guoqi
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China; School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin, 300071, P.R. China.
authors.forename: Song
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
authors.forename: Lihai
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
authors.forename: Peifu
authors.initials: P
authors.lastname: Tang
mesh_terms: D005264:Femoral Fractures / Q000601:surgery*; D005269:Femur; D006801:Humans; D018889:Ilizarov Technique; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D013977:Tibia; D013978:Tibial Fractures / Q000601:surgery*