复合骨形态发生蛋白(BMP)的微小颗粒骨修复兔桡骨缺损的实验研究

目的探讨自体或深低温冷冻同种异体微小颗粒骨复合胶原、骨形态发生蛋白(BMP)修复节段性兔桡骨缺损的效果。方法将兔自体或同种异体骨研磨成微小颗粒，分别与BMP及Ⅰ型胶原复合，并采用兔桡骨干1．5cm缺损的动物模型，通过X线、组织学、骨密度、生物力学等检测手段，与自体微小颗粒骨复合胶原修复节段性骨缺损的疗效比较。结果自体或深低温冷冻同种异体微小颗粒骨复合BMP胶原比自体微小颗粒骨复合胶原成骨效果优良，其中复合BMP组在8周即可使骨缺损修复，髓腔通畅，在骨缺损修复各时期，其成骨速度及成骨量均好于未复合BMP组。结论自体或深低温冷冻同种异体微小颗粒骨复合胶原BMP均可有效地修复节段性骨缺损，两种方法促进新骨形成无明显差异，异体微小颗粒骨复合胶原BMP是良好的骨缺损修复材料。     

骨形态发生蛋白治疗开放性胫骨骨折的Meta分析

目的:系统评价骨形态发生蛋白(BMP)治疗开放性胫骨骨折的疗效。方法:计算机检索Cochrane Library、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库和维普数据库,并手工检索相关领域杂志。检索不受语种限制,时间均从建库至2012年4月,收集骨形态发生蛋白治疗开放性胫骨骨折的所有随机对照试验。根据Cochrane协作网推荐的"风险评估工具"进行偏倚风险评估,用RevMan 5.1软件进行统计学分析。结果:最终纳入3个随机对照试验,共851例患者。研究结果显示:和对照组相比,BMP治疗开放性胫骨骨折未提高其骨折愈合率[RR=1.16,95%CI(0.95,1.41),P=0.15],但是可减少二次干预发生情况[RR=0.72,95%CI(0.58,0.89),P=0.003];在不良事件发生率方面,BMP治疗开放性胫骨骨折后发生感染[RR=1.31,95%CI(0.94,1.81),P=0.11]和疼痛的不良事件[RR=0.92,95%CI(0.79,1.08),P=0.30]与对照组差异无统计学意义。结论:骨形态发生蛋白治疗开放性胫骨骨折有一定的效果。由于纳入研究质量和病例数量的局限,上述结论尚需要更多高质量的随机对照试验进一步验证。     

Treatment of long bone non-unions with polytherapy: indications and clinical results

The incidence of long bone non-unions has been estimated to range between 5 and 10%. Autologous bone graft usually harvested from the iliac crest continues to be the gold standard for biological enhancement of atrophic non-unions. However, its use has been hampered by minor and major donor site complications. Moreover despite possessing the properties of osteogenecity, osteoconductivity and some osteoinductivity the overall results of treatment have not been consistent with disappointing success rates at times. The concept of polytherapy for the treatment of non-unions, namely the simultaneous application of the three fundamental elements of the diamond concept, osteoprogenitor cells, growth factor and osteoconductive scaffold, appears to be an attractive alternative but more studies are desirable to validate this strategy.     

A systematic review of comparative studies on bone graft alternatives for common spine fusion procedures

Background

The increased prevalence of spinal fusion surgery has created an industry focus on bone graft alternatives. While autologous bone graft remains the gold standard, the complications and morbidity from harvesting autologous bone drives the search for reliable and safe bone graft substitutes. With the recent information about the adverse events related to bone morhogenetic protein use, it is appropriate to review the literature about the numerous products that are not solely bone morphogenetic protein.

Purpose

The purpose of this literature review is to determine the recommendations for use of non-bone morphogenetic protein bone graft alternatives in the most common spine procedures based on a quantifiable grading system.

Study design

Systematic literature review.

Methods

A literature search of MEDLINE (1946–2012), CINAHL (1937–2012), and the Cochrane Central Register of Controlled Trials (1940–April 2012) was performed, and this was supplemented by a hand search. The studies were then evaluated based on the Guyatt criteria for quality of the research to determine the strength of the recommendation.

Results

In this review, more than one hundred various studies on the ability of bone graft substitutes to create solid fusions and good patient outcomes are detailed.

Conclusion

The recommendations for use of bone graft substitutes and bone graft extenders are based on the strength of the studies and given a grade.     

自体骨移植与骨替代物手术治疗胫骨平台骨折的Meta分析

目的：通过Meta分析系统评价自体骨移植和骨替代物治疗胫骨平台骨折的临床疗效。方法：计算机检索2005年1月至2022年8月PubMed、Web of Science、中国知网、万方等数据库已发表的关于自体骨移植和骨替代物治疗胫骨平台骨折的病例对照研究文献。根据纳排标准进行文献筛选及数据提取,对入选的随机对照研究（randomized controlled trial,RCT）采用Cochrane手册中的干预性Meta分析标准进行质量评价。采用RevMan 5.3软件对两种方法的关节凹陷、关节面二次塌陷率、失血量、手术时间和感染率进行Meta分析。结果：共纳入7项RCT研究,424例患者,其中骨替代物组296例,自体骨移植组128例。两组手术时间[MD=-16.79,95%CI(-25.72,-7.85),P=0.000 2],出血量[MD=-70.49,95%CI(-79.34,-61.65),P<0.000 01]比较,差异有统计学意义。而关节凹陷[MD=-0.17,95%CI(-0.91,0.58),P=0.66],关节面二次塌陷率[RR=-0.74,95%CI(0.35,...     

骨形态发生蛋白复合物联合自体骨髓移植治疗四肢长管状骨骨不连

目的:观察骨形态发生蛋白复合物联合自体红骨髓移植治疗四肢长管状骨骨不连的临床疗效.方法:自2004年1月至2010年12月,采用骨形态发生蛋白复合物联合自体红骨髓移植法治疗四肢长管状骨骨不连患者36例,男22例,女14例;年龄22～68岁,平均36.8岁.骨不连部位:肱骨6例,尺骨4例,桡骨3例,股骨10例,胫骨13例.伤后距治疗时间8～24个月,平均13.7个月.增生性骨不连22例,萎缩性骨不连14例 患者主要临床症状为骨折部位负重时疼痛,肢体肿胀X线片提示骨折线清晰伴骨缺损.术后通过观察手术切口愈合、植骨区及骨髓穿刺区反应、骨折愈合、邻近的关节功能恢复等情况评估手术疗效.结果:术后患者切口均甲级愈合,未发现过敏和免疫排斥反应.骨髓穿刺区无感染及血肿形成.36例患者均获随访,时间3～28个月,平均16.2个月.无骨髓穿刺区慢性疼痛、植骨区骨质感染、切口周围皮肤红肿或窦道形成.骨不连均获得骨性愈合,愈合时间3～12个月,平均6.2个月,无畸形愈合.骨不连愈合后骨折部位负重时疼痛消失、肢体肿胀消退.5例患者遗留邻近关节功能部分受限,其余患者均完全恢复.结论:骨形态发生蛋白复合物联合自体红骨髓移植在治疗四肢长管状骨骨不连中具有来源广泛、安全可靠、加速骨愈合等优点,是其理想的植骨材料之一.     

加入和未加骨形态发生蛋白2的打压植骨术治疗股骨头坏死

背景：已知骨形态发生蛋白2（bone morphogenetic protein2,BMP2）能促进骨愈合,但能否加速股骨头坏死打压植骨术的修复尚不知。目的：回顾性对照分析加入和未加入BMP2的打压植骨术治疗股骨头坏死（osteonecrosis of the femoral head,ONFH）的疗效。方法：42例（72髋）非创伤性ONFH手术患者获得随访,男19例,女23例;手术时年龄22~54岁,平均30.9岁。手术方法为经髋关节前路,股骨头颈交界处开窗,坏死灶清除,人工骨打压植骨。第一组每例加入4mgrhBMP2,第二组未加。患髋按国际骨循环学会（Association Research Circulation Osseous,ARCO）分期,按中日友好医院（China-Japan Friend-ship Hospital,CJFH）分型。临床疗效按Harris髋关节功能评分（Harris hip score,HHS）评定,影像学按股骨头是否塌陷及病灶修复情况评定。结果：随访5~7.8年（平均6.1年）。优36髋,良12髋,尚可7髋。股骨头保存率76.4%,第一组为81.8%,第二组为71.8%（P=0.459）。ARCOⅡ期为90.3%,Ⅲa期为34.6%（P=0.0285）;CJFH-C型及L1型为95.3%,L3型为29.6%（P=0.050）。结论：经股骨头颈开窗病灶清除,打压植骨术在选择合适的非创伤ONFH患者（ARCOⅡb,c期及CJFHC型和L1型）可获得优良的中期疗效。加入rhBMP2可提高手术疗效和骨修复质量。     

Recombinant human bone morphogenetic protein 2 enhances bone healing in an experimental model of fractures at risk of non-union

INTRODUCTION: Identification of patients at risk of developing non-union and institution of procedures preventing non-union could be attractive in routine fracture management. We investigated whether recombinant human bone morphogenetic protein (rhBMP-2) delivered in a hyaluronic acid carrier could prevent non-union development in an experimental non-union model, which simulates the clinical situation of open mid-tibial fractures. METHODS: Sixteen rabbits underwent a standard non-union operation comprising mid-tibial osteotomy, excision of periosteum and endosteum, and plate fixation. Before closure of the wound eight rabbits received interfragmentary deposition of 200 microg rhBMP-2 delivered in a hyaluronan gel carrier, and eight rabbits received gel carrier alone. RESULTS: After 7 weeks, torsional failure moment of the osteotomy and energy absorbed at failure, macroscopic and radiographic appearance, callus area, and interfragmentary bone volume fraction confirmed that rhBMP-2 delivery significantly improved bone healing. Blood flow at the osteotomy site, measured using radiolabelled microspheres, was not higher in the united osteotomies than in non-united osteotomies. DISCUSSION: rhBMP-2 delivered in a hyaluronic acid carrier-induced formation of competent bone in an experimental model of compromised healing. We, therefore, propose interfragmentary deposition of rhBMP-2 delivered in a hyaluronic acid carrier to patients encountering fractures at risk of non-union or delayed union.     

骨形态发生蛋白复合物联合自体红骨髓移植治疗四肢良性骨肿瘤与瘤样病变

<正>四肢良性骨肿瘤与瘤样病变的主要治疗方法是将肿瘤病灶清除后,用植骨材料填充骨缺损,并根据骨缺损的情况适当辅助内固定或外固定。如何选择植骨材料修复病理性骨缺损     

Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein-2

The use of bone morphogenetic protein-2 (rhBMP-2) in spinal fusion has increased dramatically since an FDA approval for its use in anterior lumbar fusion with the LT cage. There are several reports of its use in transforaminal lumbar interbody fusion, posterolateral fusion, and anterior cervical fusion. Reports on adverse effects of rhBMP-2 when used in spinal fusion are scarce in literature. An Institutional Review Board approved retrospective study was conducted in patients undergoing anterior spinal fusion and instrumentation following diskectomy at a single center. Forty-six consecutive patients were included. Twenty-two patients treated with rhBMP-2 and PEEK cages were compared to 24 in whom allograft spacers and demineralized bone matrix was used. Patients filled out Cervical Oswestry Scores, VAS for arm pain, neck pain, and had radiographs preoperatively as well at every follow up visit. Radiographic examination following surgery revealed end plate resorption in all patients in whom rhBMP-2 was used. This was followed by a period of new bone formation commencing at 6 weeks. In contrast, allograft patients showed a progressive blurring of end plate-allograft junction. Dysphagia was a common complication and it was significantly more frequent and more severe in patients in whom rhBMP-2 was used. Post operative swelling anterior to the vertebral body on lateral cervical spine X-ray was significantly larger in the rhBMP-2 group when measured from 1 to 6 weeks after which it was similar. These effects are possibly due to an early inflammatory response to rhBMP-2 and were observed to be dose related. With the parameters we used, there was no significant difference in the clinical outcome of patients in the two groups at 2 years. The cost of implants in patients treated with rhBMP-2 and PEEK spacers was more than three times the cost of allograft spacers and demineralized bone matrix in 1, 2, and 3-level cases. Despite providing consistently good fusion rates, we have abandoned using rhBMP-2 and PEEK cages for anterior cervical fusion, due to the side effects, high cost, and the availability of a suitable alternative.     

Nanocomposite therapy as a more efficacious and less inflammatory alternative to bone morphogenetic protein‐2 in a rodent arthrodesis model

The use of recombinant human bone morphogenetic protein‐2 (rhBMP‐2) in spine fusion has led to concerns regarding a potential accompanying inflammatory response. This study evaluates a combination therapy (TrioMatrix®; Pioneer Surgical, Inc., Marquette, MI) comprised of a demineralized bone matrix (DBM), hydroxyapatite, and a nanofiber‐based collagen scaffold in a rodent spine fusion model. Thirty‐six athymic rats that underwent a posterolateral intertransverse spinal fusion were randomly assigned to 1 of 5 treatment groups: absorbable collagen sponge alone (ACS, negative control), 10 µg rhBMP‐2 on ACS (positive control), TrioMatrix®, Grafton® (Osteotech, Inc., Eatontown, NJ), and DBX® (Synthes, Inc., West Chester, PA). Both TrioMatrix® and rhBMP‐2‐treated animals demonstrated 100% fusion rates as graded by manual palpation scores 8 weeks after implantation. This rate was significantly greater than those of the ACS, Grafton®, and DBX® groups. Notably, the use of TrioMatrix® as evaluated by microCT quantification led to a greater fusion mass volume when compared to all other groups, including the rhBMP‐2 group. T2‐weighted axial MRI images of the fusion bed demonstrated a significant host response associated with a large fluid collection with the use of rhBMP‐2; this response was significantly reduced with the use of TrioMatrix®. Our results therefore demonstrate that a nanocomposite therapy represents a promising, cost‐effective bone graft substitute that could be useful in spine fusions where BMP‐2 is contraindicated. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1812–1819, 2011     

Application of rhBMP-7 and platelet-rich plasma in the treatment of long bone non-unions: A prospective randomised clinical study on 120 patients

The purpose of this prospective randomised clinical study was to compare the efficacy of recombinant bone morphogenetic protein 7 (rhBMP-7) and platelet-rich plasma (PRP) as bone-stimulating agents in the treatment of persistent fracture non-unions.One hundred and twenty patients were randomised into two treatment groups (group rhBMP-7 vs. group PRP). Sixty patients with sixty fracture non-unions were assigned to each group (median age: 44 years, range 19–65, for the rhBMP-7 group and 41 years, range 21–62, for the PRP group, respectively). In the rhBMP-7 group, there were 15 tibial non-unions, 10 femoral, 15 humeral, 12 ulnar, and 8 radial non-unions. In the PRP group, there were 19 tibial non-unions, 8 femoral, 16 humeral, 8 ulnar, and 9 radial non-unions. The median number of operations performed prior to our intervention was 2 (range 1–5) and 2 (range 1–5) with autologous bone graft being used in 23 and 21 cases for the rhBMP-7 and PRP groups, respectively.Both clinical and radiological union occurred in 52 (86.7%) cases of the rhBMP-7 group compared to 41 (68.3%) cases of the PRP group, with a lower median clinical and radiographic healing time observed in the rhBMP-7 group (3.5 months vs. 4 months and 8 months vs. 9 months, respectively). This study supports the view that in the treatment of persistent long bone non-unions, the application of rhBMP-7 as a bone-stimulating agent is superior compared to that of PRP with regard to their clinical and radiological efficacy.     

Bone morphogenetic protein 2 accelerates osteointegration and remodelling of solvent-dehydrated bone substitutes

Introduction lt was the purpose of this study to investigate how bone morphogenetic protein 2 (BMP-2) influences remodelling and the biomechanics of solvent-dehydrated bone in the long run. Furthermore, the early influence of this growth factor on the substitute was investigated.Materials and methods Using a weight-bearing animal model, solvent-dehydrated bone was implanted in the tibial head of merino sheep (n=12) after being loaded with BMP-2 (100 g/100 l). At 4 weeks (n=6) and 9 months (n=6) after surgery, histomorphological, histomorphometrical and biomechanical investigations were performed.Results At 9 months after implantation of BMP-2-loaded specimens, the bone per tissue volume was high, with levels above those of physiological cancellous bone. The amount of remaining solvent-dehydrated bone was markedly decreased, and in contrast, the amount of newly formed bone was extremely high. The specimen degradation had already occurred within the first 4 weeks after implantation, showing no further impact throughout the 9-month period. Biomechanical investigations at 9 months after implantation demonstrated a yield strength which achieved levels at least equivalent to physiological cancellous bone. BMP-2 showed no significant impact on the biomechanical properties after 4 weeks, compared to specimens prior to implantation.Conclusion BMP-2 predominantly has an impact on the early implant degradation as well as bone formation, which leads to an almost completed bone remodelling of the solvent-dehydrated specimen within the study period of 9 months.     

rhBMP in lumber fusion for lumbar spondylolisthesis: A systematic review and meta-analysis

Purpose

To compare the efficacy and safety of recombinant human bone morphogenetic protein (rhBMP) and iliac crest autograft in the fusion treatment of lumbar spondylolisthesis.

一种新型生物活性人工骨的制备及成骨活性的研究

目的：研制CPC/BMP复合人工骨,检测其成骨活性。方法：制备CPC/BMP及CPC骨块,扫描电子显微镜观察表面结构。用小鼠肌袋植入实验观察材料的成骨活性。结果：BMP在CPC中呈微球状均匀分布。CPC植入小鼠肌袋内不能诱导,CPC/BMP植入后1周有软骨细胞出现,2周有编织骨,4周以后小梁骨生成,16周出现成熟的板层骨。同时材料出现降解迹象。有机质含量、碱性磷酸酶浓度在CPC/BMP组出现升高,扫描电镜结果同样证实有新骨形成。结论：CPC/BMP生物活性人工骨可异位诱导成骨,可望成为新型的骨缺损修复材料。     

柠檬酸钙载体复合骨形态发生蛋白-2成骨的实验研究

目的 研究柠檬酸钙与骨形态发生蛋白-2(BMP-2)复合后成骨的作用.方法 取2月龄雄性昆明小鼠15只,通过体外实验获取柠檬酸钙与BMP-2最佳比例,在体外将10 mg柠檬酸钙与2mg BMP-2复合后,植入小鼠股部肌肉上中,行肌袋实验.以柠檬酸钙与BMP-2复合物为实验组,单独BMP-2为对照组,术后2、4、6周取材进行大体标本观察与组织学观察,计算新骨形成面积比及新生骨密度比.结果 大体标本观察与组织学观察示实验组成骨明显高于对照组,成骨面积较对照组明显增多.2、4、6周时比较差异均有统计学意义(P＜0.05);2、4、6周时骨密度测量实验组较对照组高,差异均有统计学意义(P＜0.05).实验组骨质2周时出现骨小梁结构,成熟度高,成骨细胞数量多,分化明显,成骨密度高;4周时骨的成熟度增高,更多粉红色骨质形成,骨质基本成熟,骨小梁增粗增大,出现大面积成骨区域;6周时血管化及骨髓腔形成充分,骨质密度高.结论 柠檬酸钙与BMP-2复合后具有良好的诱导成骨作用,可促进骨形成,是一种较理想的载体材料,可作为一种新型复合人工骨修复骨缺损.     

Telopeptide-depleted bovine skin collagen as a carrier for bone morphogenetic protein

The telopeptide of type I collagen is thought to be responsible for causing immunogenic response when introduced into xenogenic hosts. To eliminate this problem, solubilized bovine skin collagen was filtered through a millipore membrane, digested repeatedly with pepsin to remove telopeptides, and used as a carrier for a water-soluble, partially-purified fraction of bone morphogenetic protein (BMP) in mice. Composite implants of this telopeptide-depleted collagen and the partially-purified BMP fraction consistently elicited ectopic bone formation in mice 3 weeks postimplantation. When implanted alone, collagen or BMP failed to show this response. Collagens, prepared by use of conventional methods (acid-solubilized collagen, or collagen-digested once with pepsin) were also assessed as carriers for BMP, but were found to be inferior in terms of consistency of bone formation and amount of induced bone mass. The results suggest that telopeptide-depleted collagen permitted a gradual release of purified BMP for induction of bone, with minimal immunogenic interference. Consequently, this collagen carrier represents an important development for future clinical application of BMP.     

Recombinant human bone morphogenetic protein-2: adverse events reported to the Manufacturer and User Facility Device Experience database

Background context

Adverse effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) in spinal surgery have previously been observed. However, because of its size, scope, and nature, the US Food and Drug Administration’s database of postmarketing reports is useful for detecting new and unexpected safety concerns.

Purpose

To characterize adverse events reported to the FDA; to characterize off-label use of rhBMP-2.

Study design

Review of adverse events reported to the FDA after the use of rhBMP-2 (INFUSE Bone Graft) in spinal surgery.

Methods

The Manufacturer and User Facility Device Experience database was searched for the brand name “infuse bone graft,” for reports received from July 2, 2002, through August 31, 2011. Adverse events were reviewed, summarized, and classified by an MD. For each report, the most important clinical entity was identified as the principal adverse event. Off-label uses were summarized.

Results

Of 834 reports, four (0.5%) described procedures in which rhBMP-2 was used in accordance with the approved indication. Nearly half of all the reports, 370 (44.4%), stated that the patient required revision surgery or other invasive interventions to address the reported adverse event. Swelling, fluid collections, osteolysis, pain/radiculopathy, heterotopic bone, pseudarthrosis, surgical site infections and other wound complications, thromboembolic events, respiratory distress, cancer, and other events were reported.

Conclusions

Because of their duration, scope, and expense, prospective studies designed to estimate the risk of rare adverse events may be impractical. Despite its imperfections, postmarketing surveillance helps to narrow the focus by revealing patterns and prioritizing topics for further research. One should not extrapolate from these results to the rhBMP-2 experience as a whole; the findings reported here might not be representative. This analysis indicates that serious adverse events can occur after the use of rhBMP-2 in spinal surgery and raises many points that surgeons may wish to consider when deciding when and how to use this product in their patients.     

How to store autologous bone graft perioperatively: an in vitro study

INTRODUCTION: Autologous bone graft is the golden standard for bone grafting, but little is known about the influence of various preservation techniques used during surgery immediately following harvest on the osseous structures and graft vitality. Several studies focussed on the optimal treatment of the bone during harvest and implantation, but only few examined the intraoperative storage conditions on the back table. The aim of our study was to examine the influence of various intraoperative preservation techniques on human cancellous bone at different points to optimize the storage during surgery. MATERIALS AND METHODS: Cancellous bone was harvested during hip arthroplasty and stored for 2 and 4 h under dry conditions, inside a swab moistened with saline solution or in saline solution, 5% glucose solution or culture medium. After the storage period, the bone was cultured and examined 7 days after the first cells grew out in one of these groups. Following the identification of the cells as osteoblast-like cells, the cultures were analysed by fluorescence staining, cell count and the XTT-test. RESULTS: Fluorescence staining revealed no avital cells in all groups. Dry storage of the bone led to significantly lower cell metabolism after 2 h compared to saline solution and 5% glucose solution. The same was true after 4 h dry storage compared to the moistened swab, and glucose and culture medium. Cell count was significantly lower after 2 h of dry storage compared to saline solution and culture medium. CONCLUSIONS: Perioperative storage of cancellous bone under dry conditions should be avoided. The bone graft should be stored in saline or 5% glucose solution or a moistened swab.     

Outcome analysis of ilizarov and monorail fixators in the treatment of nonunion of long bones: A systematic review and proportion meta-analysis

IntroductionNonunion of long bones is a major complication following fractures that requires a substantial amount of investment both monetary and time from patients and surgeons. The need to comprehensively understand the complications, outcomes and distraction capability is profound, which necessitates a review of current evidence on special fixators used for distraction. The current systematic review aims to study the available literature on distraction osteogenesis using special fixators (Ilizarov and Limb Reconstruction System) in the management of nonunion (infected and non-infected).MethodsCochrane Library, PubMed, Scopus were searched until January 2022. The review included all original studies which used Ilizarov or Monorail Fixators/LRS in the treatment of nonunion of long bones. The quality of studies was assessed using the Modified Coleman Methodology Score.ResultsA total of 35 original studies with Ilizarov (n = 29) and LRS (n = 8) were selected including two comparative studies. The pooled data meta-analysis and the subgroup analysis of these studies found both Ilizarov and LRS fixator yield similar functional outcomes for the treatment of long bones nonunion.ConclusionThe review was conducted to understand the scenario of nonunion in long bones. Pin tract infection is found to be the most common complication followed by adjacent joint stiffness and deformity. In our review we observed that both external fixator time and index were lower in LRS compared to Ilizarov group. Further RCT are required comparing Ilizarov and LRS fixators to effectively comment upon the superiority of the implants.