Functional outcome following bone transport reconstruction of distal tibial defects.
BACKGROUND
Little has been written about the functional outcome of patients treated with bone transport to reconstruct a distal tibial defect. The aim of this study was to investigate the functional capabilities of patients who had undergone reconstruction with distraction osteogenesis for the treatment of a distal tibial defect in one lower limb.


METHODS
At least eighteen months after completion of treatment, eight patients who had no pain and were able to walk and climb stairs without difficulty performed isometric ankle plantar flexion maximum voluntary contractions while the electromyographic activity of the tibialis anterior and triceps surae muscles was simultaneously recorded. Seven of the patients also underwent gait analysis. Data for the involved limb were compared with those collected for the contralateral limb.


RESULTS
During gait, stance time (p = 0.01), the plantar flexion angular displacement and peak moment developed during the second half of stance (p < 0.046), and the amount of ankle power generated (p = 0.02) were significantly decreased in the involved limb compared with the contralateral limb. Similar decreases were observed in the plantar flexion (p = 0.01) and dorsiflexion (p = 0.01) maximum voluntary contractions and the corresponding electromyographic activity (p = 0.01).


CONCLUSIONS
These results suggest that adaptive changes had occurred at the level of the transported muscles, which affected both routine and maximal effort capabilities. These findings contribute to our understanding of the functional limitations of patients who have undergone bone transport with its obligatory shortening of muscle length.
Giannikas
Konstantinos A
KA
Department of Optometry, University of Bradford, United Kingdom. kostas.giannikas@lineone.net
Maganaris
Constantinos N
CN
Karski
Michael T
MT
Twigg
Peter
P
Wilkes
Richard A
RA
Buckley
John G
JG
D000328:Adult; D000843:Ankle Joint / Q000502:physiology; D004576:Electromyography; D016267:External Fixators; D005260:Female; D005684:Gait; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D019857:Osteogenesis, Distraction; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D013977:Tibia / Q000502:physiology / Q000601:surgery*; D013997:Time Factors; D016138:Walking / Q000502:physiology