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

Abstract

Background We present a case of an immense unprecedented tibial bone lengthening of 33.5 cm. The management of chronic osteomyelitis of the right tibia with subtotal tibial bone defect, talus defect and equinus ankle deformity. We demonstrate limb reconstruction by distraction osteogenesis and correction of ankle deformity with the Ilizarov technique. Limb salvage was preferred as an alternative to amputation to restore basic limb function. Case presentation A 16-year-old male patient fell and injured his right lower leg. He attempted to treat the symptoms with traditional home remedies. During 15 months of self-treating, he developed osteomyelitis of the right tibia and had lost function in his foot. Radiology revealed immense bone defect of the right tibia, including talus bone defect and equinus deformity of the calcaneus. The patient’s right tibia was non weight-bearing, had drainage sinus just below his knee and a large scar anteriorly along the entire length of the tibia. Conclusion Upon completion of treatment, the patient was able to avoid amputation of his leg with partially restored function for weight-bearing. He carried himself without assistance after 3 years of lost function in his right leg. Tibial bone distraction osteogenesis of 33.5 cm was done after 90% of the tibial length was defected. To the best of our best knowledge, this case is one of a kind to achieve distraction of tibial bone to such length.

Effect of Annular External Fixator-Assisted Bone Transport on Clinical Healing, Pain Stress and Joint Function of Traumatic Massive Bone Defect of Tibia

“…(1) patients with contraindications related to surgical treatment; (2) patients with old fractures; (3) patients with osteoporosis; (4) patients with a history of tibial surgery; (5) patients with severe blood system diseases; (6) patients complicated with severe organ dysfunction; (7) patients with severe diabetes; and (8) patients with fractures at other sites.…”

“…According to previous literature, unilateral external fixator bone lengthening is one of the effective methods for the treatment of traumatic massive bone defect of tibia. It can repair bone defects of any length without bone grafting, and the ossification rate of new bone callus is faster, which can greatly shorten the bone healing time, and the operation method is relatively simple compared with the annular external fixator [6,7]. However, this method still has some limitations, and some patients still have no improvement in knee and ankle function after treatment [8].…”

Repair of critical diaphyseal defects of lower limbs by 3D printed porous Ti6Al4V scaffolds without additional bone grafting: a prospective clinical study

“…[1][2][3]. Because of variable anatomical locations and geometries, conditions of periosteum and soft tissue, biomechanical environments, as well as patients' basic conditions, its treatment still remains surgical, socioeconomic and investigative challenges [2][3][4]. In particular, diaphyseal bone defect of lower limbs appears to be more challengeable due to its higher requirement for weight-bearing and walking function.…”