Simultaneous treatment of tibial bone and soft-tissue defects with bone transport

Abstract

Objective To explore the curative efficacy of simultaneous treatment of tibial bone and soft-tissue defects with external fixator and bone transport.Methods From February 2006 to October 2012,7 patients with tibial bone and soft tissue defects were treated by bone transport at our department.They were 4 men and 3 women,with an average age of 31.8 years (from 16 to 52 years).All their fractures were Gustlio type Ⅲ B and 3 of them were complicated with infection.Their average Mangled Extremity Severity Score (MESS) was 4.8 points (from 4 to 6 points).Their average soft tissue loss after debridement was 30.4 cm2 (from 12 to 70 cm2),and their average bone defect was 9.2 cm long (from 4 to 17 cm).Distal tibial osteotomy for proximal migration to repair the bone defect was used in 4 cases of proximal tibial defect while proximal tibial osteotomy for distal migration was used in the other 3 cases of distal defect.The wounds were covered by vacuum sealing drainage (VSD) dressing or filled with povidone-iodine gauze.Results The average follow-up period was 19.3 months (from 9 to 36 months).Bone defects were repaired in all.Primary bone healing was achieved in 5 cases while bone grafting had to be performed in the other 2 cases to repair bone non-union after bone transport.The average healing index (healing time/defect length) was 1.8 month/cm.The wounds were healed in all the 7 cases,6 of which obtained primary healing and one of which healed after skin grafting.The average time for wound healing was 3.3 months (from 2.5 to 6.0 months).Footdrop was observed in 2 cases and pin track infection in one.Conclusion Simultaneous treatment of complex defects at lower extremity with external fixator and bone transport should be recommended,because it is simple and efficient. Key words: Bone transplantation; Tibia; Wounds and injuries; External fixator; Tissue defect