Bone transport using a unilateral versus circular external fixator over an intramedullary nail in the treatment of tibial bone defect caused by infection: a retrospective comparative study

Abstract

Background The purpose of the study was to compare the clinical efficacy of bone transport with either circular or unilateral external fixators over an intramedullary nail (EFOIN) in the treatment of tibial bone defects caused by infection. Methods Between May 2010 and January 2019, clinical and radiographic data were collected and analyzed for patients with bone defects caused by infection. Thirteen patients underwent bone transport using a unilateral external fixator over an intramedullary nail (Group A), while 12 patients were treated with a circular external fixator over an intramedullary nail (Group B). The bone and functional outcomes of both groups were assessed and compared using the Association for the Study and Application of the Method of the Ilizarov (ASAMI) criteria, and postoperative complications were evaluated according to the Paley classification. Results A total of 25 patients were successfully treated with bone transport using EFOIN, with a mean follow-up time of 31.63 ± 5.88 months. There were no significant statistical differences in age, gender, previous surgery per patient, duration of infection, DS, EFT, EFI, BUT, and follow-up time between Group A and Group B (P > 0.05). However, statistically significant differences were observed in operation time and intraoperative blood loss between the two groups (P < 0.05). The excellent and good rate of bone and functional results were higher in Group A compared to Group B (76.9% vs 75% and 84.6% vs 58.3%). Statistically significant differences were observed in functional results and complication per patient between the two groups (P < 0.05). Conclusions Bone transport using a combined technique of EFOIN proved to be an effective method in treating tibial bone defects caused by infection. In comparison to circular external fixators, bone transport utilizing a unilateral external fixator over an intramedullary nail resulted in fewer complications and better functional outcomes.