Bone Defects in Tibia Managed by the Bifocal vs. Trifocal Bone Transport Technique: A Retrospective Comparative Study

Abstract

BackgroundThe purpose of this study is to evaluate the clinical effectiveness and determine the differences, if any, between the trifocal bone transport (TFT) technique and the bifocal bone transport (BFT) technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator.MethodsA total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from the period January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8 ± 12.4 years (range 19–65 years). Out of these, 32 patients were treated by the BFT technique, and the remaining 21 patients were managed by the TFT technique. The demographic data, operation duration (OD), docking time (DT), external fixation time (EFT), and external fixation index (EFI) were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by following the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical visit.ResultsAll patients achieved an infection-free union finally, and there was no significant difference between the two groups in terms of demographic data and both ASAMI bone and functional scores (p > 0.05). The mean defect size and OD in TFT (9.4 ± 1.5 cm, 161.9 ± 8.9 min) were larger than that in BFT (7.8 ± 1.8 cm, 122.5 ± 11.2 min) (p < 0.05). The mean DT, EFT, and EFI in TFT (65.9 ± 10.8 days, 328.0 ± 57.2 days, 34.8 ± 2.1 days/cm) were all less than those in BFT (96.8 ± 22.6 days, 474.5 ± 103.2 days, 60.8 ± 1.9 days/cm) (p < 0.05). Difficulties and complications were more prevalent in the BFT group than in the TFT group (p < 0.05).ConclusionBoth the trifocal and BFT techniques achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. The TFT technique can significantly decrease the DT, EFT, EFI, difficulties, and complications compared with the BFT technique.

Bifocal versus trifocal bone transport for the management of tibial bone defects caused by fracture-related infection: a meta-analysis

“…A comprehensive literature search was performed by two independent authors (KL and HYZ), and the quality of the methodology was assessed, which yielded 5 eligible articles [ 11 – 15 ]. Possible conflicts were resolved by a third reviewer.…”

A comparative study of bone union and nonunion during distraction osteogenesis

“…The HI was calculated as the duration of complete consolidation (three cortices in distraction callus) in days divided by the length gained in centimeter, whereas the LI was the number of months required to achieve 1 cm lengthening [ 26 , 27 ]. In addition, the EFI was calculated as dividing the using period of frames (days) by the distracted length of the bone (cm) [ 18 ]. All these three were decent and reliable indicators to reflect the bone healing potential, as well as the clinical outcome in DO.…”

“…Pixel value ratio (PVR) is mainly utilized to assess the maturity of late callus and the timing to remove the external fixator [ 13 – 17 ]. In addition, the lengthening index (LI), healing index (HI) and external fixator index (EFI) is served as general indicator to analysis bone healing during DO [ 18 ]. However, these above indicators were only considered in bone union cases.…”

Optimization of the arrangement of ring-spice-rod fixators on the experimental data base during the treatment of tibia nonunion

“…Основним загальноприйнятим і широко застосовуваним є метод лікування модифікованими апаратами Ілізарова шпіце-стрижневого типу. Зовнішня фіксація в лікуванні незрощень довгих кісток гомілки за допомогою кільцевих шпіце-стрижневих фіксаторів (КШСФ), що набула поширення по всьому світу, має наступні переваги -реконструкція відбувається живою кісткою без шкоди для здорових тканин інших областей, з достатньою міцністю і довговічністю стійкістю до інфекції та довічно відновленою функцією (Abulaiti A. et al, 2022;Liu, Y. et al, 2020;Veselý, R., & Procházka, V., 2016).…”

“…За даними різних авторів (Kornah, B. A. et al, 2016;Aktuglu, K. et al, 2019;Abulaiti A. et al, 2022)…”