The effect of periosteum deficiency on the treatment of lower extremity segmental bone defect with Ilizarov bone transport technique

Objective To investigate the effect of periosteum deficiency on the treatment of segmental bone defect of lower extremity by Ilizarov bone transport Technique. Methods From April 2009 to April 2016, data of 54 cases with lower limb segmental bone defect who were treated by Ilizarov bone transport technique were retrospectively analyzed. According to intraoperative observation of the distribution of periosteum at the osteotomy site, all cases were divided into two groups. There were 10 cases in absent periosteum group, including 6 males and 4 females, aged from 23 to 57 years old (mean, 38.20±9.90 years old). There were 3 cases locating at femur, and 7 cases at tibia. 4 cases had non-infective bone defect, while the other 6 had infective bone defect. Segmental bone defect ranged from 4.0 to 14.0 cm (mean, 6.85±2.87 cm). There were 44 cases in normal periosteum group, including 32 males and 12 females, aged from 22 to 65 years old (mean, 38.90±10.10 years old). There were 9 cases locating at femur and 35 cases at tibia. 12 cases had non-infective bone defect, while 32 cases had infective bone defect. Segmental bone defect ranged from 4.0 to 9.0 cm (mean, 6.09±1.54 cm). Visual analogue scale (VAS) was used to estimate the pain during bone transport. The distraction index, bone healing index, external fixator index was collected to evaluate the distraction osteogenesis and mineralization. The Paley method was utilized to appraisal the function of proximal joints in bone transport. Results All the 54 cases were followed up for 24-48 months, with an average of 28.50±5.70 months. All skin and soft tissue defects were satisfied healed. All limbs were restored to their original lengths, and bone healing was eventually achieved. There were no statistically significant differences in the distraction index, bone healing index, external fixator index, VAS between absent periosteum group (12.29±1.04 d/cm, 39.00±3.96 d/cm, 51.25±3.69 d/cm, 3.30±1.77 score) and normal periosteum group (11.67±0.96 d/cm, 38.07±4.22 d/cm, 49.74±4.25 d/cm, 3.36±1.66 score)(P>0.05). Paley adjacent joint function evaluation showed no statistically difference between absent periosteum group [good rate 100%(10/10)] and normal periosteum group [good rate 97.7% (43/44)] (P=0.901). The overall incidence of complications was 20.0% (2/10) in the absence of periosteum group, with 1 case of mild infection and 1 cases of tissue contracture incarcerated at the docking site. The overall incidence of complications was 27.3% (12/44) in the normal of periosteum group, with 2 cases of mild infection, 3 cases of poor limb strength alignment, 6 cases of tissue contracture incarcerated at the docking site and 1 case of severe foot drop deformity. There was no statistically significant difference in the overall incidence of complications between the two groups (P=0.636). Conclusion The absence of periosteum at the epiphyseal osteotomy site has no significant effect on Ilizarov bone transport technique in the treatment of segmental bone defects of lower limbs in bone regeneration and healing, mineralization and bone remodeling, and does not increase the incidence of complications. Key words: Lower extremity; Periosteum; Ilizarov technique; External fixators