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Stoneburner et al. Plast Aesthet Res 2020;7:13 I http://dx.doi.org/10.20517/2347-9264.2019.028 Page 7 of 18
n = 91
n = 91
n = 91 n = 78
n = 13 n = 7
n = 8
n = 14
Figure 1. Flow diagram of the literature search
Table 1. Studies included in systematic review
Ref. No. of Mean age No. of lower No. of upper Average time of repair Frame Avg follow
patients (years) extremities extremities from injury (months) up (years)
Lowenberg et al. [81] 34 40 34 0 NR Ilizarov frame 11
Musharafieh et al. [82] 3 NR 3 0 0.71 Anterior double-stacking 1.5
Bibbo [83] 1 37 1 0 24 Ilizarov frame 2
Duman et al. [84] 9 22 9 0 NR Ilizarov frame NR
Fiebel et al. [65] 1 41 1 0 24 Ilizarov frame 3
Lowenberg et al. [61]
Simultaneous group 13 31 12 1 NR Ilizarov frame 2
Delayed group 23 44 20 3 NR Ilizarov frame 2
Spiro et al. [9] 5 42 5 0 NR Modified Ilizarov in 3 pts, NR
Ilizarov frame in 2 pts
Tukiainen and Asko-Seljavaara [7] 4 31 4 0 NR Ilizarov frame NR
Minehara et al. [85] 1 18 1 0 0.6 Ilizarov or hybrid frame NR
Boopalan and Jepegnanam [86] 2 27.5 2 0 7.5 Ilizarov frame 1
Lowenberg and Van der Reis [87] 1 23 1 0 12 Ilizarov frame 1.25
Hutson et al. [88] 18 32 19 0 1.13 Ilizarov frame 4.83
Chim et al. [89] 28 45 28 0 36.1 Taylor spatial frame 4.1
Isik et al. [90] 2 NR 2 0 NR Ilizarov frame NR
NR: not reported
on average (range of 1-11 years). Indications for surgery included chronic osteomyelitis or nonunion (58.2%
of patients) and acute trauma with or without infection (41.8% of patients) [Table 2]. No studies included
patients with tumors or masses. The average time from injury was 1.1 years (range of 18 days to 3 years) in 8 of
[7]
[81]
the 14 articles. An additional 2 of the 14 articles reported two separate times from injury: 1 or 3 weeks for
[81]
[7]
patients with acute trauma and 10 or 18 months for patients with chronic osteomyelitis or nonunion.
All 14 articles described a surgical approach. In 11 of the 14 articles, the authors used a classic Ilizarov
frame; in one, they used either an Ilizarov frame or segmental transport external fixator; and, in one, they
used a hexapod frame. Only 1 of the 14 used anterior double-stacking external fixation. Some patients
