Bone transport procedure as an effective technique in managing large bone defect of tibia
Keywords:
Large bone defect, bone transport, Ilizarov, outcomeAbstract
Introduction:
Bone defects are serious issues in post-severe trauma conditions of the lower limb. Osteomyelitis may arise following untreated or even treated injuries leading to extensive bone resection. In addition, poor soft tissue condition makes the treatment more difficult that sometimes results in amputation and length discrepancy. Bone transport procedure using external fixator is considered as the most beneficial in managing large bone defects as well as soft tissue damage without the need of large amount of bone grafting material, which has high risk of failure.
Methods:
We present a serial case of six males and one female, with age ranging from 12-47 years old, experiencing large bone defects of 10 cm or more in the tibia following extensive resection due to severe trauma and osteomyelitis in Fatmawati General Hospital. Seven patients were obtained from 2008 until 2016 with follow-up time of 2 years. Ilizarov frames were applied in all patients to perform bone transport distraction osteogenesis through osteotomy at proximal or distal metadiaphysis area of the rest segment, which subsequently allowed for recovery of poor soft tissue condition. One millimeter a day the distraction performed until docked and compressed at the edge of the rest segment. In patient 2, bifocal transport was conducted from the proximal segment and then continued from the distal segment until docked to each other in the middle. In patient 1, 3, and 4 conversions into internal fixation were performed to shorten the Ilizarov period.
Results:
All large bone defects were restored along with soft tissue recovery. In patient 1, 3, and 4, Ilizarov were converted into internal fixation for more comfort and easier exercise. No complications of infection, neurovascular disturbance, nonunion and joint stiffness were found. Conclusions: Bone transport is a safe and effective choice to treat large bone defects of tibia by any cause of trauma complications, mostly osteomyelitis. Ilizarov frame provided stable construction that allowed for transport procedure while enhancing union at the docking site and poor soft tissue recovery. No bone graft was needed to fill the defect in the tibia. Amputation and length discrepancy could, therefore, be avoided.
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