Tetrafocal bone transport of the tibia with circular external fixation: a case report.

Most open fractures associated with motor-vehicle accidents are severe, and 65% to 75% of all open tibial fractures that result from motor-vehicle accidents are Gustilo type III in severity1. The exposed location of the tibia in motorcyclists was confirmed by Zettas et al., who reported that the tibia was the bone most frequently fractured during motorcycle accidents and that 19.2% of all motorcycle-related fractures were of the tibia2. The treatment of bone defects in this clinical setting can be very challenging3. To date, several bone transport techniques have been developed and are included in Ilizarov’s classification of distraction-compression osteosynthesis and related distraction-osteogenesis methods4. These techniques can be divided into three groups—monofocal, bifocal, and trifocal—on the basis of the number of distraction-compression sites5. Here we report the case of a patient in whom a tibial bone defect was treated with bifocal bone transport in two locations at the same time. We have chosen to call this technique tetrafocal bone transport . The tibial defect was bifocal, affecting both the proximal and distal metadiaphyseal regions of the tibia. We assembled a suitable Ilizarov frame to distract two separate osteotomies done in the middle fragment to fill the proximal and distal bone defects with bone transported from the middle segment. A thorough search of the literature revealed no reports on tetrafocal bone transport for tibial bone defects. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-two-year-old man was in a motorcycle accident and presented to the emergency department of a nearby hospital with a Gustilo type-IIIB open fracture of the left tibia with bone loss. The wound was irrigated and debrided, and a Hoffmann-II external fixator (Stryker, Mahwah, New Jersey) was applied. Ischemia …