The Art of Tibial Bone Transport Using the Ilizarov Fixator

Abstract

Complex tibial fractures are common injuries, particularly in high-energy trauma; segmental bone loss, soft tissue compromise, infection, and nonunion are frequent considerations. Segmental tibial bone loss can be present after these injuries acutely, or can be the consequence of operative resection for multiple reasons, including osteomyelitis, nonunions, and tumors. Among the various available treatment options, distraction osteogenesis with the Ilizarov frame has proven to be a uniquely effective way of generating new bone mass to fill the defect, and thus restore tibial length and continuity. The senior author has over 25 years of experience using the Ilizarov method and fixator, and describes in detail his technique of applying an Ilizarov frame for antegrade tibial bone transport as a form of bifocal osteosynthesis for complex posttraumatic reconstruction. The suspension wire technique discussed here very reliably aligns the frame precisely with the intact proximal tibia in a consistent manner. This makes it easier to perform a bone transport that restores skeletal continuity and reconstructs the limb with an anatomic alignment of the foot and ankle relative to the remainder of the patient’s body. The protocol for docking site modification described here will ensure that bony union is achieved and limb length is restored at the conclusion of the transport. Together, these techniques allow this complex method of limb salvage and reconstruction to be performed very predictably and most efficiently. Level of Evidence: V—expert opinion.