Ilizarov bone transport versus fibular graft for reconstruction of tibial bone defects in children

Abstract

The aim of this study was to compare the results of treatment of segmental tibial defects in the pediatric age group using an Ilizarov external fixator versus a nonvascularized fibular bone graft. This study included 24 patients (age range from 5.5 to 15 years) with tibial bone defects: 13 patients were treated with bone transport (BT) and 11 patients were treated with a nonvascularized fibular graft (FG). The outcome parameters were bone results (union, deformity, infection, leg-length discrepancy) and functional results: external fixation index and external fixation time. In group A (BT), one patient developed refracture at the regenerate site, whereas, in group B (FG), after removal of the external fixator, one of the FGs developed a stress fracture. The external fixator time in group A was 10.7 months (range 8-14.5) versus 7.8 months (range 4-11.5 months) in group B (FG). In group A (BT), one patient had a limb-length discrepancy (LLD), whereas, in group B (FG), three patients had LLD. The functional and bone results of the Ilizarov BT technique were excellent in 23.1 and 30.8%, good in 38.5 and 46.2, fair in 30.8 and 15.4, and poor in 7.6 and 7.6%, respectively. The poor functional result was related to the poor bone result because of prolonged external fixator time resulting in significant pain, limited ankle motion, whereas the functional and bone results of fibular grafting were excellent in 9.1 and 18.2%, good in 63.6 and 45.5%, fair in 18.2 and 27.2%, and poor in 9.1 and 9.1%, respectively. Segmental tibial defects can be effectively treated with both methods. The FG method provides satisfactory results, with early removal of the external fixator. However, it had a limitation in patients with severe infection and those with LLD. Also, it requires a long duration of limb bracing until adequate hypertrophy of the graft. The Ilizarov method has the advantages of early weight bearing, treatment of postinfection bone defect in a one-stage surgery, and the possibility to treat the associated LLD. However, it has a long external fixation time.

Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

“…Currently, Ilizarov reconstructions, the Masquelet technique, vascularised and non-vascularised bone grafts and bone substitutes are the main methods to treat tibia defects [2,8,9,[17][18][19][20][21][22]. However, bone transfer is the preferred technique for the treatment of infected tibial bone defects [1,4,23,24].…”

“…The occurrence and progression of infectious bone defects of the tibia are often associated with severe wound infection, soft-tissue defects, vascular and nerve injuries, and joint dysfunction, rendering treatment difficult [1][2][3][4][5][6]. Most studies [1,2,[7][8][9] recommend the Ilizarov technique to repair tibial bone defects because it has several advantages. First, infection can be strictly controlled.…”

Bone transport versus acute shortening for the management of infected tibial bone defects: A meta-analysis

“…Currently, Ilizarov reconstructions, the Masquelet technique, vascularised and non-vascularised bone grafts and bone substitutes are the main methods to treat tibia defects. [2,8,9,[17][18][19][20][21][22] However, bone transfer is the preferred technique for the treatment of infected tibial bone defects. [1,4,23,24] Ilizarov reconstruction techniques include two main clinical treatment protocols: bone transport (BT) and acute shortening and gradual lengthening (ASD).…”

“…The occurrence and progression of infectious bone defects of the tibia are often associated with severe wound infection, soft-tissue defects, vascular and nerve injuries, and joint dysfunction, rendering treatment difficult. [1][2][3][4][5][6] Most studies [1,2,[7][8][9] recommend the Ilizarov technique to repair tibial bone defects because it has several advantages. First, infection can be strictly controlled.…”

Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

“…The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon,The occurrence and progression of infectious bone defects of tibia is often associated with severe wound infection, soft tissue defects, vascular and nerve injuries, and joint dysfunction, so its treatment full of difficulty. [1][2][3][4][5][6] Most research [1,2,[7][8][9] recommend Ilizarov technique reconstruction to repair tibial bone defects because it has several advantages. First, infection can be clinical datas was complete.…”