Massive segmental bone loss due to pantibial osteomyelitis in children reconstructed by medial fibular transport with Ilizarov frame

Abstract

Objectives Vascularized or non-vascularized fibula transport is a novel procedure for limb salvage but has been associated with high failure rates and complications. Ipsilateral medial fibular transport (IMFT) using Ilizarov apparatus is a modification of the procedure to prevent complications and increase success rate. This article presents the largest series of limb salvage for massive tibial bone loss in children due to pan-osteomyelitis by IMFT with Ilizarov apparatus. Methods A case series of 12 patients with a mean age of 12 (6–18) years is described. At the first stage of surgery, the excision of all dead bone was performed, and Ilizarov without traction apparatus was applied. In second stage, ipsilateral fibula is gradually transferred to tibial defect with the help of ilizarov olive wires. In the third stage, the freshening of docking sites of fibula to tibia was performed. The minimum follow up was of two years. Results Hypertrophy of the transported fibula accompanied by full weight bearing and satisfactory joint motion occurred in all patients. Removal of sequestrated bone resulted in control of infection in 27.17 ± 7.76 days. Fibular transport took 16.58 ± 4.14 days. The length of tibial bone loss replaced by fibula was 9.50 ± 2.23 cm. The mean days required for union after freshening of the docking site was 76.58 ± 6.20 days. Conclusions Ilizarov frame for pan tibial osteomyelitis with bone excision and medial fibular transport works well for limb salvage in children.

Tibialization of fibula in critical bone defect due to post traumatic osteomyelitis of the tibial shaft: A case report

“…This is different from having non-vascularized bone grafts, while also being osteoconductive, osteoinductive and osteogenic, the grafts underwent creeping substitution process, which includes capillary, perivascular tissue and inflammatory cells invasion then gradually revascularized and ultimately absorbed to form the incorporation of the graft with the host bone. Expected long term result of tibialization is the complete incorporation of the fibula replacing the missing gap and becoming a tibia for all purposes [ 8 ].…”

Unprecedented tibial bone lengthening of 33.5 cm by distraction osteogenesis for the reconstruction of a subtotal tibial bone defect. A case report and literature review

“…The limb discrepancy at presentation in addition to the massive defect appeared inapplicable as the available length of fibula for transfer is 20-24 cm. Furthermore, this procedure would extend the treatment period resulting in a significant increase in hospital cost [9,[11][12][13]. Bone graft was impractical; even from multiple donor sites, the harvested bone would not be enough to fill the massive void and is associated with morbidity of donor site [6].…”

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100thbirthday of G. A. Ilizarov)

“…One more technique is ipsilateral fibula expansion that is an option of radial instead of longitudinal distraction osteogenesis. Gradual fibular transfer with the Ilizarov external fixator was used in post-traumatic and post-infection large tibial bone defects[ 47 , 48 ]. Although the induced membrane technique has gained much popularity in bone defect treatment, the Ilizarov bone transport remains the main tool in the situations with bone deformity and limb length discrepancy[ 31 ].…”

“…The basic osteotomy techniques were discussed in regard to bone formation and the study stressed the importance of the procedure for qualitative distraction osteogenesis[ 73 ]. The regular 1-mm rate of daily lengthening, confirmed in the historical experiments by the Ilizarov’s team[ 4 ], should be followed with any fixator or adjusted down if problems appear in order to have stable bone regeneration[ 48 ]. The regenerate condition and consolidation is of primary concern to allow full weight-bearing[ 74 ].…”