Bifocal corticotomy and bone transport for large segmental defects of the infected tibia and soft tissue

Abstract

Objective To evaluate the techniques of bifocal corticotomy and bone transport for large segmental defects of the infected tibia and soft tissue and their complications as well. Methods From May, 2009 to May, 2014, 25 patients with large segmental defects of the infected tibia and soft tissue were treated at our center. They were 23 males and 2 females, from 2 to 52 years of age (average, 31.2 years). All the cases were Gustilo type Ⅲ B. The defect size of the soft tissue ranged from 8 cm × 4 cm to 24 cm × 12 cm; the length of tibia defects was from 8.5 cm to 18.2 cm, averaging 12.3 cm. After debridement, the tibia was fixated with Ilizarov external fixator. Bifocal corticotomy was performed on the proximal and distal tibial metaphyses simultaneously. The transporting speeds for proximal and distal tibial segment were 1 mm/d and 0.6 mm/d initially, and lowered to 0.5~0.6 mm/d later until the 2 bone segments connected. The bone transport lasted for 40 to 150 days, averaging 69.6 days. Results The patients were followed up for 12 to 72 months (average, 26.6 months). The soft tissue wound healed uneventfully and the bone defects were reconstructed. Of the 25 cases, 22 obtained primary bone union. Nonunion of the bone segments occurred in one, wound infection and osteogenesis imperfect in bone lengthening area occurred in one, and cut and pull-out of K-wires in the osteoporotic tibial ends occurred in one. These complications were treated accordingly before bone union was achieved. The other complications were also treated accordingly, including serious pin tract infection in 2 cases, re-fracture after removal of the external fixator in one, and shift of the tibial alignment in 2 cases. Conclusions Bifocal corticotomy can decrease bone transport time for large segmental defects of the tibia and soft tissue. During the long treatment period, a surgeon must pay much attention to the technical details and management of complications. Key words: Tibia; Bone lengthening; Complications; Ilizarov technique