Bone transport over an intramedullary nail: A case report with histologic examination of the regenerated segment

Abstract

Bone transport is useful for the treatment of segmental defects, non-union and osteomyelitis. Bone transport has been compared to conventional techniques for the treatment of segmental defects and infection and found to provide better restoration of leg length, to need less cancellous grafting, to have fewer graft fractures and to require less operating time and hospital stay and to have a lower disability [ 1 Cierny G. Zorn K.E. Segmental tibial defects: comparing conventional and Ilizarov methodologies. Clin Orthop. 1994; 301: 118-123 PubMed Google Scholar , 2 Green S.A. Skeletal defects: a comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop. 1994; 301: 111-117 PubMed Google Scholar , 3 Williams M.O. Longterm costcomparison of major limb salvage using the Ilizarov method versus amputation. Clin Orthop. 1994; 301: 156-158 PubMed Google Scholar ]. When comparing bone transport with cancellous grafting rates of union and infection have been found to be similar [ 1 Cierny G. Zorn K.E. Segmental tibial defects: comparing conventional and Ilizarov methodologies. Clin Orthop. 1994; 301: 118-123 PubMed Google Scholar , 2 Green S.A. Skeletal defects: a comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop. 1994; 301: 111-117 PubMed Google Scholar , 3 Williams M.O. Longterm costcomparison of major limb salvage using the Ilizarov method versus amputation. Clin Orthop. 1994; 301: 156-158 PubMed Google Scholar ]. Bone transport over an intramedullary nail has been reported in animal studies [ 4 Lin V. Huang S. Lui T. Chapman M. Limb lengthening over an intramedullary nail: an animal study and clinical report. Clin Orthop. 1996; 330: 208-216 Crossref PubMed Scopus (29) Google Scholar , 5 Schemitsch E.H. Kowalski M.J. Swionkowski M.F. Harrington R.M. Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia. J Orthop Res. 1995; 13: 382-389 Crossref PubMed Scopus (77) Google Scholar ] and in small clinical trials [ 6 Paley D. Catagni M.A. Argnani F. Villa A. Benedetti G.B. Cattaneo R. Ilizarov treatment of tibial non-unions with bone loss. Clin Orthop. 1989; 241: 146-165 PubMed Google Scholar , 7 Prokuski L.J. Marsh J.L. Segmental bone deficiency after acute trauma: the role of bone transport. Orthop Clin North Am. 1994; 25: 753-763 PubMed Google Scholar , 8 Tornetta P. Bergman M. Watnik N. Berkowitz G. Steuer J. Treatment of grade IIIB open tibial fractures: a prospective randomized comparison of external fixation and nonreamed locked nailing. J Bone Joint Surg. 1994; 76: 13-17 Google Scholar , 9 Watson J.T. Anders M. Moed B.R. Management strategies for bone loss in tibial shaft fractures. Clin Orthop. 1995; 315: 138-152 PubMed Google Scholar ]. There are clear advantages to intramedullary fixation during bone transport, including improved rigidity of the fixation construct [ 8 Tornetta P. Bergman M. Watnik N. Berkowitz G. Steuer J. Treatment of grade IIIB open tibial fractures: a prospective randomized comparison of external fixation and nonreamed locked nailing. J Bone Joint Surg. 1994; 76: 13-17 Google Scholar , 10 Brunner U.H. Cordey J. Kessler S. Rahn B.A. Schweiberer L. Perren S.M. Bone segment transport in combination with an intramedullary nail. Injury. 1993; 24S: 29-44 Abstract Full Text PDF Scopus (12) Google Scholar ]. This has been suggested to be an important mechanical factor for optimal regeneration; other advantages include maintenance of anatomic length and alignment and early removal of the external fixation system, permitting improved patient mobilisation and muscle function [ [11] Raschke M.J. Mann J.W. Oedekoven G. Claudi B.F. Segmental transport after reamed intramedullary nailing: preliminary report of a ‘monorail’ system. Clin Orthop. 1992; 282: 233-240 PubMed Google Scholar ].