title: Treatment of tibial defect and bone nonunion with limb shortening with external fixator and reconstituted bone xenograft.
abstract: OBJECTIVE
  To explore the effect of external fixator and reconstituted bone xenograft (RBX) in the treatment of tibial bone defect, tibial bone nonunion and congenital pseudarthrosis of the tibia with limb shortening.
  
  
  METHODS
  Twenty patients (13 males and 7 females) with tibial bone defect, tibial bone nonunion or congenital pseudarthrosis of the tibia with limb shortening were treated with external fixation. Two kinds of external fixators were used: a half ring sulcated external fixator used in 13 patients and a combined external fixator in 7 patients. Foot-drop was corrected at the same time with external fixation in 4 patients. The shortened length of the tibia was in the range of 2-9 cm, with an average of 4.8 cm. For bone grafting, RBX was used in 12 patients, autogenous ilium was used in 3 patients and autogenous fibula was implanted as a bone plug into the medullary canal in 1 case, and no bone graft was used in 4 patients.
  
  
  RESULTS
  All the 20 patients were followed-up for 8 months to 7 years, averaging 51 months. Satisfactory function of the affected extremities was obtained. All the shortened extremities were lengthened to the expected length. For all the lengthening area and the fracture sites, bone union was obtained at the last. The average healing time of 12 patients treated with RBX was 4.8 months.
  
  
  CONCLUSIONS
  Both the half ring sulcated external fixator and the combined external fixator have the advantages of small trauma, simple operation, elastic fixation without stress shielding and non-limitation from local soft tissue conditions, and there is satisfactory functional recovery of affected extremities in the treatment of tibial bone defects, tibial bone nonunion and congenital pseudarthrosis of the tibia combined with limb shortening. RBX has good biocompatibility and does not cause immunological rejections. It can also be safely used in treatment of bone nonunion and has reliable effect to promote bone healing.
authors.affiliation: Orthopaedic Department of Xijing Hospital, Fourth Military Medical University, Xian 710032, China.
authors.forename: Zhi-Gang
authors.initials: ZG
authors.lastname: Wang
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.forename: Yun-Yu
authors.initials: YY
authors.lastname: Hu
authors.forename: Guo-Lin
authors.initials: GL
authors.lastname: Meng
authors.forename: Ge-Le
authors.initials: GL
authors.lastname: Jin
authors.forename: Zhi
authors.initials: Z
authors.lastname: Yuan
authors.forename: Hai-Qiang
authors.initials: HQ
authors.lastname: Wang
authors.forename: Xian-Wen
authors.initials: XW
authors.lastname: Dai
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000601:surgery; D013977:Tibia / Q000473:pathology / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery; D014184:Transplantation, Homologous; D016896:Treatment Outcome