Ilizarov bone transport over a primary tibial nail and free flap: a new technique for treating Gustilo grade 3b fractures with large segmental defects

Abstract

The management of Gustilo grade 3B open tibial fractures is demanding and controversial, particularly when there is associated bone loss. The technique used for initial fracture stabilisation remains contentious, but there is evidence suggesting that unreamed intramedullary nailing may be the most appropriate particularly with large segmental defects [ [1] Torneta P. Bergman M. Watnik N. Berkowitz G. Steuer J. Treatment of grade-3B open tibial fractures: a prospective randomised comparison of external fixation and non-reamed locked nailing. Journal of Bone and Joint Surgery. 1994; 76B: 13-19 Google Scholar ]. Adequate well-vascularised cover must be provided to the defect following debridement to minimise the risk of sepsis and non-union which are common sequelae of this injury [ [2] Feibel R.J. Oliva A. Jackson R.L. Louie K. Buncke H.J. Simultaneous free-tissue transfer and Ilizarov distraction osteosynthesis in lower extremity salvage: case report and review of the literature. Journal of Trauma. 1994; 2: 322-328 Crossref Scopus (36) Google Scholar ]. Callus distraction, first introduced by Ilizarov, has become a popular means of filling traumatic segmental tibial defects [ 3 Raschke M.J. Mann J.W. Oedekoven G. Claudi B.F. Segmental transport after unreamed intramedullary nailing: preliminary report of a “Monorail” system. Clinical Orthopaedics and Related Research. 1992; 282: 233-240 PubMed Google Scholar , 4 Watson J.T. Anders M. Moed B.R. Management strategies for bone loss in tibial shaft fractures. Clinical Orthopaedics and Related Research. 1995; 315: 138-152 PubMed Google Scholar , 5 Prokuski L.J. Marsh J.L. Segmental bone deficiency after acute trauma: the role of bone transport. Orthopaedic Clinics of North America. 1994; 25: 753-763 PubMed Google Scholar ]. This may be with an Ilizarov circular frame or by using a unilateral distraction device [ [6] Green S.A. Jackson M.J. Wall D.M. Marinow H. Ishkanian J. Management of segmental defects by the Ilizarov intercalary bone transport method. Clinical Orthopaedics and Related Research. 1992; 280: 136-142 PubMed Google Scholar ].