Speeded gradual lengthening and secondary angled blade plate stabilisation for proximal tibial shaft non-union with shortening

Abstract

Eighteen patients with proximal tibial shaft nonunion and shortening were treated. In each patient, the nonunion area was débrided, realigned and stabilised with an Ilizarov lengthening frame. The tibia was gradually lengthened by 1-1.5 mm per day. After achieving the desired length, external fixation was converted to an angled blade plate and packed with cancellous bone graft. Follow-up of 16 patients for a median of 2.4 (1.2-4.5) years revealed satisfactory outcomes in all. No wound infections were noted. The described technique has a high success rate, a short treatment course and reduces patient discomfort. This method may be considered preferential treatment for all patients with the specified indications.

Does Lengthening and Then Plating (LAP) Shorten Duration of External Fixation?

“…Lengthening followed by plating was first described and popularized by Wagner in 1978 [32]. Variations of this technique have been described in a case report [1] and short case series [8,14,22,31,33]. These variations include using a circular external fixator instead of Wagner device [31,33], lengthening over a locking plate [1,14], external fixator removal before plate application [33], and using this approach for bone transport as opposed to traditional bone lengthening [1].…”

“…Variations of this technique have been described in a case report [1] and short case series [8,14,22,31,33]. These variations include using a circular external fixator instead of Wagner device [31,33], lengthening over a locking plate [1,14], external fixator removal before plate application [33], and using this approach for bone transport as opposed to traditional bone lengthening [1]. Concerns with these approaches are crosscontamination between external and internal hardware [14,22,31,33], and loss of alignment when the external fixator is removed before plate application [33].…”

Does Integrated Fixation Provide Benefit in the Reconstruction of Posttraumatic Tibial Bone Defects?

“…The consolidation phase of distraction osteogenesis serves as a natural point of intervention to remove the external fixator, thus shortening the time patients are in the frame. However, the conversion to internal fixation must avoid any iatrogenic contamination and be strong enough to stabilize the immature bone (regenerate) [1,9,25,28,39,41]. The onerous patient experience with traditional Ilizarov reconstruction is a powerful way to completely restore nearnormal anatomy and restoration of function in a cost-effective manner [23].…”

“…The consolidation phase is typically twice as long as the distraction phase, making it an effective source of intervention to decrease the time the patient spends in the external fixator. This can be achieved by supplanting the external fixator with internal fixation during, or subsequent to, lengthening and deformity correction, respectively [1,9,25,28,39,41]. The use of internal fixation with intramedullary nails or plates and screws has been described to stabilize the regenerate allowing for earlier external fixator removal [10,16,33].…”

Submuscular plating of the femur through an anterior approach after bone distraction

“…New strategies have been developed for decreasing the external fixator time and to reduce complications such as infection, joint stiffness, deformity and re-fractures in the regenerated segment. Several authors have published their experience using different internal fixation methods after the distraction period; these include techniques such as lengthening over locking plates or nails [ 7 ], nail insertion or plating after the lengthening [ 8 , 9 ] with the fixator in situ, or removal of the external fixator prior to the application of the plates in one [ 10 ] or two surgical stages [ 11 , 12 ].…”