Management of traumatic tibial defects using free vascularized fibula or Ilizarov bone transport: A comparative study

Abstract

There are several options for the treatment of traumatic tibial defects. Among these options, free vascularized fibula and Ilizarov bone transport are well-known and effective techniques. The differences between both techniques and the indications for each of them are not well studied in the literature. Between September 1995 and December 2004, Ilizarov bone transport and free vascularized fibula were used to treat 25 traumatic bone. Patients were divided into two groups, Ilizarov group (12) and free fibula group (13). Preoperative data, operative data, duration of treatment, functional outcome, range of motion loss, number of secondary procedures, and type and rate of complications were compared in both groups. All the cases were ultimately united in both groups. Operative time and blood loss were significantly higher in the free fibula group. Although external fixation time was longer in the Ilizarov group, the overall duration of treatment was similar. Range of motion loss was less in the Ilizarov group, but the overall functional outcome was similar. There was no difference in complication rate, or number secondary procedures. Defect size was found to have the most significant effect on the results. Results were much better in the free fibula group when the defect length was 12 cm or more while the results were better in Ilizarov group when the defect length was less than 12 cm. We recommend using free vascularized fibula for traumatic tibial defects of 12 cm or more, whenever experience is available.

Long bone reconstruction using multilevel lengthening of bone defect fragments

“…At present, the two prevailing methods for bone defect repair that provide vascular ties of the graft with the soft tissues are the Ilizarov non-free bone plasty and free vascularized grafts. They are considered to be methods of choice, and the studies that compared the efficiency of these two methods stated that there were no great advantages between them in obtaining anatomic integrity or functional outcomes [12][13][14].…”

Ilizarov non-free bone plasty for extensive tibial defects

“…Therefore, the patients were advised not to bear weight on the operated limb until the graft hypertrophy developed. Moreover, free bone plasty with arteriovenous shunting results in a prolonged and traumatic intervention followed by administrations of medication [4,9].…”

“…Therefore, the use of vascularised autografts for extensive tibial defects was considered to be the most effective method of reconstructive bone surgery [5][6][7]. Nowadays, the Ilizarov non-free bone plasty and free vascularised autografts have been universally acknowledged as two alternative ways for bone defect management [8,9].…”

Comparison of 39 post-traumatic tibia bone transports performed with and without the use of an intramedullary rod: the long-term outcomes

“…However, problems with vascularised bone grafts include donor site morbidity, possibility of necrosis due to anastomotic complications, long remodelling time and high fracture rate [7][8][9][10]. The advantages of bone transport include minimal soft tissue trauma, treatment of large bone defects with regenerate of the same diameter and elimination of donor site morbidity [1,11,12].…”