title: Angular shortening and delayed gradual distraction for the treatment of asymmetrical bone and soft tissue defects of tibia: a case series.
abstract: BACKGROUND
  Acute shortening is reported to be an effective method for the treatment of open fractures with bone and soft tissue defects. Little is known about primary skin closure with angulation to the side of the defect and distraction at the fracture site.
  
  
  METHODS
  We present a series of three cases treated for defective fractures of tibia by angular shortening and delayed gradual distraction with hinged circular external fixator. Two cases were type IIIB open fractures and one case was an infected nonunion. Bone and soft tissue defects were managed by adaptation of edges and primary skin closure with angulation to the side of the defect. Axial alignment was restored by gradual distraction after a 2 to 3 weeks interval. Residual limb length discrepancy was lengthened through a separate corticotomy in two cases.
  
  
  RESULTS
  Bone formation at both the fracture and corticotomy sites were sufficient to achieve union in all patients. Fixation time averaged 261 (182-392) days and average bone healing index was 42 days/cm. No further surgical intervention was necessary for soft tissue reconstruction after primary skin closure. Infection was eradicated in the case of infected nonunion.
  
  
  CONCLUSIONS
  Angular compression to the side of the defect is a safe and reliable method of treatment for asymmetrical bone or soft tissue defects of tibia. It eliminates the need for complex soft tissue reconstruction procedures. Unnecessary debridement of bone is prevented by angular adaptation of edges. Definitive treatment of complex injuries is possible with a circular external fixator.
authors.affiliation: Department of Orthopaedics and Traumatology, Cukurova University, Faculty of Medicine, Balcali, Adana, Turkey.
authors.forename: Mahir
authors.initials: M
authors.lastname: Gulsen
authors.forename: Cenk
authors.initials: C
authors.lastname: Ozkan
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D016267:External Fixators; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007870:Leg Length Inequality / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D020127:Recovery of Function; D018570:Risk Assessment; D012494:Sampling Studies; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors