Ilizarov Bone Transport Technique Combined With Guide-pin In The Medullary Cavity For Treatment Of Post-traumatic Bone Defect Of Tibia

Objective: To investigate the clinical effect and complications of Ilizarov bone transport combined with guide-pin in the medullary cavity in the treatment of post-traumatic bone defects of tibial.Methods: A retrospective case series study was conducted to analyze the clinical data of 21 patients with post-traumatic bone defect of tibial admitted to the Third Hospital of Hebei Medical University form March 2014 to February 2019.There were 15 males and 6 females,aged 19-60 years [(39.6±12.7)years].Mechanisms of initial injury included traffic accidents injury in eleven patients,heavy object crush injury in six,fall from height injury in three and crush-related injury in one patient.The bone defect length was 4.5-14.5cm [(8.0±2.5)cm] after debridement.The defects of the anterior tibial soft tissue ranged from 6 cm×4 cm to 20 cm×15 cm in area.All patients underwent treatment with Ilizarov bone transport technique.The alignment of transport bone segment was controlled by a guide-pin in the medullary cavity of tibia.Bone grafts were performed to accelerate fracture healing of docking point.The wound healing,bone healing,external fixation time,external fixation index(EFI)were recorded.Bone and functional results were evaluated accordingly to the criteria given by Association for the Study and Application of the Method of Ilizarov(ASAMI).The complications was recorded according to Paley' s criteria.The physical component summary score(PCS)and mental component summary score(MCS)ware recorded according to the SF-36 questionnaire to evaluate the quality of life.Results: After removal of the apparatus,follow-up was(22.6±7.9)months(range,12-39 months).The Wound healing was achieved without flap transfer.All patients achieved bone healing without recurrent infection reported.Mean external fixation time was(391.3±118.2)d(range,232-663 d),and mean external fixation index was(49.3 ± 7.8)d/cm(rang,35.7-62.7 d/cm).According to the ASAMI,the excellent and good rate of bony results and functional results were 86% and 90%.According to the Paley' s criteria,Complications included 14 problems;8 obstacles and 1 sequelae.The physical component summary score(PCS)and mental component summary score(MCS)were(83.8±12.1)and(71.8±13.5).Conclusions: Ilizarov bone transfer technique is a safe and effective method to treat post-traumatic bone defect of tibia.With the guide-pin in the medullary cavity and bone grafts at docking point can be better restored lower limb alignment and accelerate fracture healing.