Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects: A RETROSPECTIVE COMPARATIVE STUDY

Aims Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated. Patients and Methods A total of 86 consecutive patients with a long tibial bone defect (≥ 8 cm), who were treated between January 2008 and January 2015, were retrospectively reviewed. A total of 45 were treated by BFT and 41 by TFT. The median age of the 45 patients in the BFT group was 43 years (interquartile range (IQR) 23 to 54). Results The size of the bone defect was significantly longer (p = 0.005), the number of previous operations was significantly higher (p < 0.001), the operating time was significantly longer (p < 0.001), and the bone transport distance was significantly increased (p = 0.017) in the TFT group. However, the external fixation time (p < 0.001), the healing index (p < 0.001), the number of additional procedures (p = 0.013), and the number of true complications (p < 0.001) were significantly reduced in this group. Both groups achieved highly satisfactory bone and functional results. Conclusion TFT can significantly reduce the treatment time, the number of additional surgical procedures, and true complications compared with BFT in the treatment of long segmental tibial bone defects.

[1]  N. Heidari,et al.  ‘Rail and Nail' bifocal management of atrophic femoral nonunion , 2018, The bone & joint journal.

[2]  T. Decoster,et al.  Management of extra‐articular segmental defects in long bone using a titanium mesh cage as an adjunct to other methods of fixation: A MULTICENTRE REPORT OF 17 CASES , 2018, The bone & joint journal.

[3]  M. Hossain,et al.  Induced membrane technique for treating tibial defects gives mixed results , 2017, The bone & joint journal.

[4]  M. El-Sayed,et al.  Ilizarov distraction osteogenesis over the preexisting nail for treatment of nonunited femurs with significant shortening , 2016, European Journal of Orthopaedic Surgery & Traumatology.

[5]  W. Azzam,et al.  Our experience in the management of segmental bone defects caused by gunshots , 2016, International Orthopaedics.

[6]  D. Borzunov,et al.  Ilizarov non-free bone plasty for extensive tibial defects , 2013, International Orthopaedics.

[7]  D. Borzunov.  Long bone reconstruction using multilevel lengthening of bone defect fragments , 2012, International Orthopaedics.

[8]  G. Lovisetti,et al.  Bone Transport for Postinfectious Segmental Tibial Bone Defects With a Combined Ilizarov/Taylor Spatial Frame Technique , 2011, Journal of orthopaedic trauma.

[9]  C. Krettek,et al.  Comparison of 39 post-traumatic tibia bone transports performed with and without the use of an intramedullary rod: the long-term outcomes , 2011, International Orthopaedics.

[10]  T. Higgins,et al.  Lower Extremity Assessment Project (LEAP)--the best available evidence on limb-threatening lower extremity trauma. , 2010, The Orthopedic clinics of North America.

[11]  M. Catagni,et al.  Tetrafocal bone transport of the tibia with circular external fixation: a case report. , 2010, The Journal of bone and joint surgery. American volume.

[12]  Kevin C. Chung,et al.  A Cost-Utility Analysis of Amputation versus Salvage for Gustilo Type IIIB and IIIC Open Tibial Fractures , 2009, Plastic and reconstructive surgery.

[13]  L. Eralp,et al.  Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. Surgical technique. , 2007, The Journal of bone and joint surgery. American volume.

[14]  H. Rashid,et al.  Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. , 2006, The Journal of bone and joint surgery. American volume.

[15]  A. Simpson,et al.  The management of fractures with bone loss. , 2005, The Journal of bone and joint surgery. British volume.

[16]  Edward Abraham,et al.  Bone transport in the management of posttraumatic bone defects in the lower extremity. , 2004, The Journal of trauma.

[17]  M. Pirela-Cruz,et al.  Management of Posttraumatic Segmental Bone Defects , 2004, The Journal of the American Academy of Orthopaedic Surgeons.

[18]  Roy Sanders,et al.  Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. , 2002, The Journal of trauma.

[19]  K. Koo,et al.  Tibial bone defects treated by internal bone transport using the Ilizarov method , 1998, International Orthopaedics.

[20]  J Aronson,et al.  Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. , 1997, The Journal of bone and joint surgery. American volume.

[21]  M. Pirela-Cruz,et al.  Vascularized bone grafts. , 1994, Orthopedics.

[22]  S. Green,et al.  Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects. , 1994, Clinical orthopaedics and related research.

[23]  B. Scott.  Transosseous osteosynthesis, theoretical and clinical aspects of the regeneration and growth of tissue , 1992 .

[24]  E. E. Johnson,et al.  The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. , 1992, Clinical orthopaedics and related research.

[25]  David M. Wall,et al.  Management of segmental defects by the Ilizarov intercalary bone transport method. , 1992, Clinical orthopaedics and related research.

[26]  Professor Dr. Gavriil A. Ilizarov.  Transosseous Osteosynthesis , 1992, Springer Berlin Heidelberg.

[27]  D. Paley,et al.  Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. , 1990, Clinical orthopaedics and related research.

[28]  D. Paley,et al.  Ilizarov treatment of tibial nonunions with bone loss. , 1989, Clinical orthopaedics and related research.

[29]  G A Ilizarov,et al.  The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. , 1989, Clinical orthopaedics and related research.