Effectiveness of bone transport with a locking plate versus conventional bone transport for tibial defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xingkuan ^1,2 , XIANG Chao ^1,2 , YAN Caiping ^1,2 , CHEN Qian ^1,2 , CHEN Lu ^1,2 ,  JIANG Ke ^1,2 ,  LI Yuling ^1,2

1. Department of Orthopedics, Affiliated Hospital of North Sichuan Medical College, Nanchong Sichuan, 637002, P. R. China;
2. Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong Sichuan, 637002, P. R. China;

Corresponding?author：

JIANG Ke, Email: jiangke2010@nsmc.edu.cn; LI Yuling, Email: lyl1987@nsmc.edu.cn

Keywords：

Bone transport with a locking plate; Orthofix fixator; Ilizarov fixator; tibial fracture; bone defect

DOI：

10.7507/1002-1892.202202073

Video：

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Objective To investigate the effectiveness difference between bone transport with a locking plate (BTLP) and conventional bone transport with Ilizarov/Orthofix fixators in treatment of tibial defect. Methods The clinical data of 60 patients with tibial fractures who met the selection criteria between January 2016 and September 2020 were retrospectively analyzed, and patients were treated with BTLP (BTLP group, n=20), Ilizarov fixator (Ilizarov group, n=23), or Orthofix fixator (Orthofix group, n=17) for bone transport. There was no significant difference in gender, age, cause of injury, time from injury to admission, length of bone defect, tibial fracture typing, and comorbidities between groups (P>0.05). The osteotomy time, the retention time of external fixator, the external fixation index, and the occurrence of postoperative complications were recorded and compared between groups. The bone healing and functional recovery were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Results All patients of 3 groups were followed up 13-45 months, with a mean of 20.4 months. The osteotomy time was significantly shorter in the BTLP group than in the Ilizarov group, and the retention time of external fixator and the external fixation index were significantly lower in the BTLP group than in the Ilizarov and Orthofix groups (P<0.05). Twenty-two fractures healed in the Ilizarov group and 1 case of delayed healing; 16 fractures healed in the Orthofix group and 1 case of delayed healing; 18 fractures healed in the BTLP group and 2 cases of delayed healing. There was no significant difference between groups in fracture healing distribution (P=0.824). After completing bone reconstruction treatment according to ASAMI criteria, the BTLP group had better bone healing than the Orthofix group and better function than the Ilizarov groups, showing significant differences (P<0.05). Postoperative complications occurred in 4 cases (20%) in the BLTP group, 18 cases (78%) in the Ilizarov group, and 12 cases (70%) in the Orthofix group. The incidence of complication in the BTLP group was significantly lower than that in other groups (P<0.05). Conclusion BTLP is safe and effective in the treatment of tibial defects. BTLP has apparent advantages over the conventional bone transport technique in osteotomy time, external fixation index, and lower limb functional recovery.

Citation： WANG Xingkuan, XIANG Chao, YAN Caiping, CHEN Qian, CHEN Lu, JIANG Ke, LI Yuling. Effectiveness of bone transport with a locking plate versus conventional bone transport for tibial defects. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 983-988. doi: 10.7507/1002-1892.202202073 Copy

1.	Nauth A, Schemitsch E, Norris B, et al. Critical-size bone defects: Is there a consensus for diagnosis and treatment? J Orthop Trauma, 2018, 32 Suppl 1: S7-S11.
2.	Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol, 2019, 20(1): 22. doi: 10.1186/s10195-019-0527-1.
3.	Hosny GA. Limb lengthening history, evolution, complications and current concepts. J Orthop Traumatol, 2020, 21(1): 3. doi: 10.1186/s10195-019-0541-3.
4.	夏青, 朱浩. Orthofix單邊外固定架骨搬運技術治療脛骨大段骨缺損. 中國骨與關節損傷雜志, 2021, 36(10): 1092-1093.
5.	Davda K, Heidari N, Calder P, et al. ‘Rail and nail’ bifocal management of atrophic femoral nonunion. Bone Joint J, 2018, 100-B(5): 634-639.
6.	陳勛, 張文韜, 喻姿瑞, 等. 單邊外固定支架聯合鋼板內固定行骨搬運術治療脛骨感染性骨不連. 中國修復重建外科雜志, 2019, 33(3): 328-331.
7.	Oh CW, Apivatthakakul T, Oh JK, et al. Bone transport with an external fixator and a locking plate for segmental tibial defects. Bone Joint J, 2013, 95-B(12): 1667-1672.
8.	Chimutengwende-Gordon M, Mbogo A, Khan W, et al. Limb reconstruction after traumatic bone loss. Injury, 2017, 48(2): 206-213.
9.	Hundal RS, Weick J, Hake M. Management of open segmental tibial fractures. J Orthop Trauma, 2021, 35(Suppl 2): S50-S51.
10.	王想福, 張萬乾, 鄭卉卉. 感染性骨缺損的治療進展. 中國骨與關節雜志, 2021, 10(6): 469-472.
11.	Tong K, Zhong Z, Peng Y, et al. Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. Injury, 2017, 48(7): 1616-1622.
12.	Dibbs RP, Ferry AM, Sarrami SM, et al. Distraction osteogenesis: mandible and maxilla. Facial Plast Surg, 2021, 37(6): 751-758.
13.	Liu Y, Yushan M, Liu Z, et al. Complications of bone transport technique using the Ilizarov method in the lower extremity: a retrospective analysis of 282 consecutive cases over 10 years. BMC Musculoskelet Disord, 2020, 21(1): 354. doi: 10.1186/s12891-020-03335-w.
14.	McNally M, Ferguson J, Kugan R, et al. Ilizarov treatment protocols in the management of infected nonunion of the tibia. J Orthop Trauma, 2017, 31 Suppl 5: S47-S54.
15.	Suda AJ. Bone segment transport for defects of the tibia: Technique with unilateral fixator and plate. Unfallchirurg, 2020, 123(9): 687-693.
16.	Gupta S, Malhotra A, Mittal N, et al. The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate. Bone Joint J, 2018, 100-B(8): 1094-1099.
17.	Runyan CM, Gabrick KS. Biology of bone formation, fracture healing, and distraction osteogenesis. J Craniofac Surg, 2017, 28(5): 1380-1389.
18.	Lu Y, Ma T, Ren C, et al. Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate. J Int Med Res, 2020, 48(4): 300060520920407. doi: 10.1177/0300060520920407.

1. Nauth A, Schemitsch E, Norris B, et al. Critical-size bone defects: Is there a consensus for diagnosis and treatment? J Orthop Trauma, 2018, 32 Suppl 1: S7-S11.
2. Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol, 2019, 20(1): 22. doi: 10.1186/s10195-019-0527-1.
3. Hosny GA. Limb lengthening history, evolution, complications and current concepts. J Orthop Traumatol, 2020, 21(1): 3. doi: 10.1186/s10195-019-0541-3.
4. 夏青, 朱浩. Orthofix單邊外固定架骨搬運技術治療脛骨大段骨缺損. 中國骨與關節損傷雜志, 2021, 36(10): 1092-1093.
5. Davda K, Heidari N, Calder P, et al. ‘Rail and nail’ bifocal management of atrophic femoral nonunion. Bone Joint J, 2018, 100-B(5): 634-639.
6. 陳勛, 張文韜, 喻姿瑞, 等. 單邊外固定支架聯合鋼板內固定行骨搬運術治療脛骨感染性骨不連. 中國修復重建外科雜志, 2019, 33(3): 328-331.
7. Oh CW, Apivatthakakul T, Oh JK, et al. Bone transport with an external fixator and a locking plate for segmental tibial defects. Bone Joint J, 2013, 95-B(12): 1667-1672.
8. Chimutengwende-Gordon M, Mbogo A, Khan W, et al. Limb reconstruction after traumatic bone loss. Injury, 2017, 48(2): 206-213.
9. Hundal RS, Weick J, Hake M. Management of open segmental tibial fractures. J Orthop Trauma, 2021, 35(Suppl 2): S50-S51.
10. 王想福, 張萬乾, 鄭卉卉. 感染性骨缺損的治療進展. 中國骨與關節雜志, 2021, 10(6): 469-472.
11. Tong K, Zhong Z, Peng Y, et al. Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. Injury, 2017, 48(7): 1616-1622.
12. Dibbs RP, Ferry AM, Sarrami SM, et al. Distraction osteogenesis: mandible and maxilla. Facial Plast Surg, 2021, 37(6): 751-758.
13. Liu Y, Yushan M, Liu Z, et al. Complications of bone transport technique using the Ilizarov method in the lower extremity: a retrospective analysis of 282 consecutive cases over 10 years. BMC Musculoskelet Disord, 2020, 21(1): 354. doi: 10.1186/s12891-020-03335-w.
14. McNally M, Ferguson J, Kugan R, et al. Ilizarov treatment protocols in the management of infected nonunion of the tibia. J Orthop Trauma, 2017, 31 Suppl 5: S47-S54.
15. Suda AJ. Bone segment transport for defects of the tibia: Technique with unilateral fixator and plate. Unfallchirurg, 2020, 123(9): 687-693.
16. Gupta S, Malhotra A, Mittal N, et al. The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate. Bone Joint J, 2018, 100-B(8): 1094-1099.
17. Runyan CM, Gabrick KS. Biology of bone formation, fracture healing, and distraction osteogenesis. J Craniofac Surg, 2017, 28(5): 1380-1389.
18. Lu Y, Ma T, Ren C, et al. Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate. J Int Med Res, 2020, 48(4): 300060520920407. doi: 10.1177/0300060520920407.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of bone transport with a locking plate versus conventional bone transport for tibial defects

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