Double-level bone transport for treatment of massive post-infectious tibial bone defects

Objective To assess the efficacy of double-level bone transport for treatment of extensive post-infectious tibial bone defects. Methods From January 2010 to May 2014, 12 consecutive patients suffering from massive postinfectious tibial bone defects were treated by the Ilizarov technique of double-level bone lengthening. The study population included 8 males and 4 females, with mean 40.9 years(range, 16-65 years). Mechanisms of initial injury included motor-vehicle injury in eight patients, explosive injury in two and crush-related injury in two. After bony resection for infection, skin defect was 8.7 cm×5.8 cm (range, 4.5 cm×2.0 cm-20.0 cm×10.0 cm) and bone defect averaged 11.0 cm (range, 6.0-20.0 cm). All patients were treated with a double-level transport (three distal-to-proximal, six both-ends-to-center and three proximal-to-distal). Three patients were candidates for flap coverage before bone transport because of large wounds, one patient had direct closure of the wound after tibial partly shortening, and the remaining patients kept the wound open during bone transport. Bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of Ilizarov (ASAMI). Results After removal of the apparatus, follow-up was (30.0±5.6)months (range, 12-36 months). All patients achieved complete union and successful eradication of infection. Mean bone transport time was (55.4±26.2)d (range, 30-125 d), with the lengthening index of (5.0±0.6)d/cm (range, 3.9-6.3 d/cm). Wound union time was (3.6±1.4)months (range, 1.5-6.0 months). Mean consolidation time of the distraction gap was (10.9±3.8)d (range, 4.0-18.0 d). Mean union time of the docking site was (8.4±3.8)months (range, 3-16.5 months). Mean external fixation time was (12.5±4.1)months (range, 5-18 months), and mean external fixation index was (1.2±0.3)months/cm(rang, 0.8-2 months/cm). According to the ASAMI, bony results were excellent in seven patients (58%) and poor in five (42%); functional results were excellent in nine patients (75%) and good in three (25%). Conclusion Double-level bone transport is an effective method that can reduce bone transport time and external fixation time. Key words: Tibia; Osteomyelitis; Ilizarov technique; Fractures, ununited