Bone Transport for Limb Reconstruction Following Severe Tibial Fractures.
A common treatment of tibial defects especially after infections is bone transport via external fixation. We compare complications and outcomes of 25 patients treated with a typical Ilizarov frame or a hybrid system for bone reconstruction of the tibia. Average follow up was 5.1 years. Particular interest was paid to the following criteria: injury type, comorbidities, development of osteitis and outcome of the different therapies. The reason for segmental resection was a second or third grade open tibia fractures in 24 cases and in one case an infection after plate osteosynthesis. Average age of the patients was 41 years (range 19 to 65 years) and average defect size 6.6 cm (range 3.0 to 13.4 cm). After a mean time of 113 days 23 tibial defects were reconstructed, so we calculated an average healing index of 44.2 days/cm. Two patients with major comorbidities needed a below knee amputation. The presence of osteitis led to a more complicated course of therapy. In the follow up patients with an Ilizarov frame had better results than patients with hybrid systems. Bone transport using external fixation is suitable for larger defect reconstruction. With significant comorbidities, however, a primary amputation or other methods must be considered.
3D-Surgery, Department of Trauma Surgery, Munich University Hospital LMU , Munich, Germany.
Julian
J
Fürmetz
3D-Surgery, Department of Trauma Surgery, Munich University Hospital LMU , Munich, Germany.
Chris
C
Soo
Department of Trauma, Reconstructive and Plastic Surgery, University Hospital Leipzig , Halle-Wittenberg, Germany.
Wolf
W
Behrendt
3D-Surgery, Department of Trauma Surgery, Munich University Hospital LMU , Munich, Germany.
Peter H
PH
Thaller
Department of Trauma and Reconstructive Surgery, Martin Luther University , Halle-Wittenberg, Germany.
Holger
H
Siekmann
Department of Trauma, Reconstructive and Plastic Surgery, University Hospital Leipzig , Halle-Wittenberg, Germany.
Jörg
J
Böhme
Department of Trauma, Reconstructive and Plastic Surgery, University Hospital Leipzig , Halle-Wittenberg, Germany.
Christoph
C
Josten
Bone transport; Ilizarov; distraction osteogenesis; fracture; tibia