Fragmental bone transport in conjunction with acute shortening followed by gradual lengthening for a failed infected nonunion of the tibia

Abstract

Ilizarov reconstructions have been regarded as potent techniques to treat infected nonunion with a large bone defect. These techniques generally include bone transport and acute shortening if it is applicable followed by gradual lengthening as well as simple bone lengthening. Fragmental bone transport has been also applied to a hemicircumferential bone defect, which is often described by cavitary osteomyelitis or hemicortical sequestrate. In these conditions, bony continuity is maintained in some part despite a bone defect on the other side that chronically drains. This technique allows sparing bone stock while preventing sacrifi ce of bony continuity from unnecessary debridement. In the following case report, we present fragmental bone transport in conjunction with acute shortening followed by gradual lengthening for treatment of an infected nonunion of the tibia. The treatment was performed according to the strategy in which living bone is effi ciently utilized so long as vascularity is confi rmed. As a result, the defect of the tibia had anterior longer and posterior shorter lengths at the single bone segment. To our knowledge, this is the fi rst report of a successful unique technique for a failed infected nonunion of the tibia with a huge bone defect that had circumferentially nonuniform defect length.