Acute shortening and re-lengthening versus antibiotic calcium sulfate-loaded bone transport for the management of large segmental tibial defects after trauma

Abstract

Background The purpose of this paper was to compare the clinical effects of acute shortening and re-lengthening (ASR) technique with antibiotic calcium sulfate-loaded bone transport (ACSBT) technique for the management of large segmental tibial defects after trauma. Methods In this retrospective study, 68 patients with large segmental tibial defects were included and completely followed. The bone loss was 3–10 cm. ASR group included 32 patients, while ACSBT group contained 36. There was no significant difference in demographic information between the two groups. The external fixation time (EFT) and external fixation index (EFI) were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification. Results The mean EFT was 9.2 ± 1.8 months in ASR group and 10.1 ± 2.0 months in ACSBT group, respectively. The mean EFI was 1.5 ± 0.2 month/cm and 1.4 ± 0.3 month/cm. According to the ASAMI criteria, in ASR group bone defect healing was excellent in 22 cases, good in 7 cases and fair in 3 cases. In ACSBT group, it was excellent in 23 cases, good in 11 cases and fair in 2 cases. In ASR group, the limb function was excellent in 15 cases, good in 7 cases and fair in 10 cases, while it was excellent in 14 cases, good in 9 cases and fair in 13 cases with ACSBT group. There was no significant difference in EFI, bone defect healing and limb functions between the two groups (p > 0.05). The mean number of complications per patient in ACSBT group was significantly lower than that in ASR group (p < 0.05). Conclusion Both techniques can be successfully used for the management of large segmental tibial defects after trauma. There was no significant difference in EFI, limb functions and bone defect healing between the two groups. Compared with ASR group, the complication incidence in ACSBT group was lower, especially the infection-related complications. Therefore, for patients with large segmental bone defects caused by infection or osteomyelitis, ACSBT technique could be the first choice.

Docking site interventions following bone transport using external fixation: a systematic review of the literature

“…Due to the nature of the intervention, all patients in the planned intervention group were treated by bone transport, whereas some in the observed group underwent acute shortening and re-lengthening (ASR) [ 33 , 35 , 37 , 38 , 41 ]. Outcomes were therefore compared only for those patients treated without routine docking site intervention (observed group) between those managed by ASR or bone transport.…”

“…Two studies in the observed group reported the use of either poly-methyl methacrylate or calcium sulphate bone cement within the defect (54 patients) [ 22 , 37 ]. The rationale for this is to induce a biologically active membrane to assist union and regenerate formation.…”

“…The majority of included studies deal with tibial bone loss [ 8 , 12 , 14 , 15 , 22 – 28 , 31 – 35 , 37 – 40 ]. This is unsurprising since the tibia is a subcutaneous bone, prone to open injuries, with a tenuous blood supply particularly in the distal third [ 45 ].…”

The accordion technique enhances bone regeneration via angiogenesis factor in a rat distraction osteogenesis model

“…The quality of bone regeneration in the distraction area relies on several factors, including osteoinductivity, osseointegration, angiogenesis of the callus, and the biomechanical environment (Inan et al,2005;Borzunov,2012;Bezstarosti et al,2021;Huang et al,2022). Published studies (Ai-Aql et al, 2008;Sojo et al,2005;Morgan et al,2012;Pacicca et al,2003) have shown that DO triggers a more intense angiogenic response compared to normal fracture healing, with neovascularization growing in the same direction as the primary mineralization front.…”