Efficacy comparison of single-level and double-level bone transport for treatment of massive post-infectious tibial bone defects

Objective To compare the clinical efficacy of single-level and double-level bone transport for treatment of massive post-infectious tibial bone defects. Methods A retrospective cohort study was made on clinical data of 36 cases of massive post-infectious tibial bone defects (>6 cm) treated by the Ilizarov technique from June 2008 to October 2015. There were 21 males and 15 females, aged (38.4±13.6)years ( range, 16-68 years). Bone defects after debridement was (9.7±3.4)cm (range, 6-20 cm). According to the site of osteotomy, the patients were allocated into single-level group (n=20) and double-level group (n=16). Bone transport time, consolidation time of the regenerate zone, union time of the docking site, external fixation time, external fixation index and complications were assessed and compared between the two groups. Bone and functional results were evaluated using the criteria given by Association for the Study and Application of the Method of Ilizarov (ASAMI). Results Duration of follow-up was (29.8±7.8)months (range, 12-40 months) after removal of the external fixator. No infection recurred, and all regenerate zones were successfully consolidated. Bone transport time in single-level group was 91.1 d (range, 60-165 d) versus 55.6 d (range, 30-125 d) in double-level group ( P 0.05). Union time of the docking site in single-level group was 9.8 months (range, 6.0-17.0 months) versus 8.2 months (range, 3.0-16.5 months) in double-level group (P>0.05). External fixation time in single-level group was 18.2 months (range, 9.5-36.0 months) versus 12.0 months (range, 5.0-18.0 months) in double-level group (P 0.05). According to the ASAMI standard, the bony results in single-level group were excellent in 10 cases and poor in 10, compared to 10 excellent and six poor results in double-level group; functional results in single-level group were excellent in 15 cases and good in five, compared to 12 excellent and four good results in double-level group (P>0.05). Conclusion Compared to single-level bone transport, double-level bone transport for treatment of massive post-infectious tibial bone defects achieve decreased external fixation index and shortened external fixation time without significant influence on the prognosis and incidence of complications. Key words: Tibial fractures; Osteomyelitis; Ilizarov technique; Fractures, ununited