Bone transport with an external fixator and a locking plate for segmental tibial defects

Abstract

Although gradual bone transport may permit the restoration of large-diameter bones, complications are common owing to the long duration of external fixation. In order to reduce such complications, a new technique of bone transport involving the use of an external fixator and a locking plate was devised for segmental tibial bone defects. A total of ten patients (nine men, one woman) with a mean age at operation of 40.4 years (16 to 64) underwent distraction osteogenesis with a locking plate to treat previously infected post-traumatic segmental tibial defects. The locking plate was fixed percutaneously to bridge proximal and distal segments, and was followed by external fixation. After docking, percutaneous screws were fixed at the transported segment through plate holes. At the same time, bone grafting was performed at the docking site with the external fixator removed. The mean defect size was 5.9 cm (3.8 to 9.3) and mean external fixation index was 13.4 days/cm (11.8 to 19.5). In all cases, primary union of the docking site and distraction callus was achieved, with an excellent bony result. There was no recurrence of deep infection or osteomyelitis, and with the exception of one patient with a pre-existing peroneal nerve injury, all achieved an excellent or good functional result. With short external fixation times and low complication rates, bone transport with a locking plate could be recommended for patients with segmental tibial defects.

Distraction osteogenesis using combined locking plate and Ilizarov fixator in the treatment of bone defect

“…described successfully bony union in two cases of large tibial bone defects using locked bridge plating and bone transfer with a monolateral external fixation frame. Oh et al 17. reported total of ten patients who underwent distraction osteogenesis with a locking plate to treat previously infected posttraumatic segmental tibial defects.…”

“…External fixation pin insertion is also simplified in the absence of an intramedullary implant. Plate-guided bone segment transport has been successfully described in literature to treat open or infected large segmental bone defect without occurrence of infection 151617…”

“…However, prolonged external fixation and presence of pin-tract infection are contraindications for the use of intramedullary fixation. Plate-guided bone transport has been successfully described in the literature 151617. In addition to the reduction to the time needed for external fixation during consolidation phase and protection against refracture, the plate helps to neutralize the forces on the bone and maintain stable anatomic alignment of the proximal and distal segment.…”

<p>A Three-Dimensional Printed Polycaprolactone Scaffold Combined with Co-Axially Electrospun Vancomycin/Ceftazidime/Bone Morphological Protein-2 Sheath-Core Nanofibers for the Repair of Segmental Bone Defects During the Masquelet Procedure</p>

“…Masquelet proposed a new solution for the healing of segmental bone defects, called the induced membrane technique. The clinical benefits of this technique have been reported, including reducing the need for tying with an external fixator for a long time (distraction osteogenesis) [1][2][3] and decreasing functional disability due to strut bone graft transplantation surgery (free vascularized fibula bone graft). 4,5 However, a major factor leading to the failure of bone union after membrane induction is a residual infection in segmental bone defects.…”

Artificial Membrane Induced by Novel Biodegradable Nanofibers in the Masquelet Procedure for Treatment of Segmental Bone Defects

“…In addition, the operation must be performed by a microsurgery specialist [4]. The second approach is the bone transport with distraction osteogenesis by the Ilizarov ring fixator, which is a standard procedure for the management of segmental bone defect applied by experienced surgeons in some medical institutes [5][6][7]. Nevertheless, various complications, including pin tract infection, failure of the transported bone consolidation, and nonunion at the docking site, have been reported [8,9].…”