Treatment of Tibial and Femoral Bone Defects With Bone Transport Over an Intramedullary Nail

Abstract

To evaluate the results of the bone transport over an intramedullary nail (BTON) technique for the treatment of segmental bone defects.Design: Retrospective review of case series. Setting: Level 1 trauma center. Patients/Participants: We included 40 patients who underwent reconstruction of the lower limb with BTON technique between 2000 and 2018. The technique was performed in the tibial segments in 21 patients and in the femoral segments in 19 patients. Intervention: The surgical technique was performed in two stages for patients with infected nonunion. Infection was eradicated in all patients at the first stage. For the BTON at the second stage, monolateral external fixators and circular external fixators were used for femoral and tibial defects, respectively. In cases of defects without any infection, debridement with a single-stage BTON was performed. Main Outcome Measurements: Complications as well as radiological and clinical results were evaluated according to the criteria of Paley-Maar. Results: Minor complications occurred in 11 patients: pin site problems (nine), cellulitis (one), skin detachment due to Schanz screw (one). Major complications occurred in eight patients: docking site nonunion (four), early consolidation and Schanz screw failure (one), knee flexion contracture (one), ankle equinus contracture (two). Four patients had osteomyelitis as residual A C C E P T E D Copyright Ó 20 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 20 4 sequelae. Bone score was excellent in 27 patients. Excellent functional results were obtained in 31 patients. Conclusions:The BTON technique is associated with low cost because of the short treatment period, low complication risk, and rapid rehabilitation and is not limited by the amount of bone transport.

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

“…A subgroup of six studies 45 , 46 , 50 , 51 , 53 , 54 , 57 focusing on the bone transport approach showed a primary union rate of 89.7% with a mean external fixator time of 6.6 months (range 4.2–9.3 months), a complication rate of 66.9%, a reintervention rate of 29.8% and a failure rate of 3.7%.…”

“…The average bone defect was 8.8 cm (range 2.7–28 cm), and the average follow-up was 35.7 months (range 6–168 months). The Ilizarov method with external fixation was used in 15 studies 35 , 36 , 46 – 50 , 52 , 56 , 59 – 62 , 65 , intramedullary nailing and/or external fixation was used in eight studies 43 , 45 , 51 , 53 – 55 , 57 , 64 , a monolateral external fixation was used in one study 44 , and bone transport with a five-ring circular external fixator in one study 58 . One of the studies in the Ilizarov group was a case–control comparing bifocal versus trifocal fibular transfer, showing better primary union rate, fewer complications and reinterventions in the trifocal group.…”

“…Then, from the end of the 90 s, more and more studies were progressively published, along with a growing interest in other approaches such as bone transport and endoprosthesis 54 , 57 , 60 – 62 , 82 – 84 . Finally, in the last years, all treatments were increasingly addressed but with a focus above all on bone transport and, also due to the impulse of new augmentation procedures, with several studies on bone allograft or autografts 27 – 29 , 31 , 35 , 36 , 45 , 50 , 51 , 53 , 56 , 59 , 77 , 91 .…”

Comparison of Iliac Bone Transplantation with Bone Transport in the Treatment of Femur Fracture and Bone Defect

“…The treatment methods for such patients are complicated; the results are not ideal; and the incidence of disability is high. During surgery, large pieces of sequestrum need to be removed, and local bone defects will also occur during the removal, which has a certain impact on the postoperative recovery of patients [ 1 ]. At present, for such patients, autologous iliac bone transplantation is mostly used.…”

A modified hybrid transport technique combined with a retrograde tibiotalocalcaneal arthrodesis nail for the management of distal tibial periarticular osteomyelitis and associated defects

“…Bas et al included 40 patients who experienced the lower limb reconstruction by hybrid transport technique from 2000 to 2018 and the total incidence of complications was 57.5%. They found that the hybrid transport technique was related to low cost due to the short treatment cycle, low complication incidence, and rapid rehabilitation [ 29 ]. Oh et al included 12 patients using the hybrid transport technique and 3 of them suffered from postoperative complications [ 26 ].…”