Elective Ilizarov Bone Transport Technique in the Treatment of Infected Tibial Bone Defect

Abstract：Objective The present study was performed to explore the clinical outcome of bone transport with the llizarov technique using an external fixator for treating infected bone defects of the tibia.Methods A total of 1 7 cases underwent elective llizarov surgery were enrolled in our hospital between Nov.2011 and Jan.2011.Bone transport was performed with llizarov circular external fixator.There were 1 3 males and 4 females,with average age of 3 6 years (range:20~59 years).The causes for bone defects included traffic accidents (9 cases),falling from a height (5 cases), bruise (3 cases).All patients were diagnosed with open fracture wounds:one with Gustilo Ⅱ open injury,five with Gustilo Ⅲ A open inj ury,seven with Gustilo Ⅲ A open inj ury and four with Gustilo Ⅲ C open inj ury.Five cases were found with bone defects on the left side,while twelve cases were found on the right sideBone defects in the upper seg-ments of the tibia were observed in 7 patients,in the middle segments of the tibia were observed in 6 patients and in the lower segments of tibia were in 4 cases.The length of defect of the tibia was 6~10 cm before bone transport.The area of the defective soft tissue after wound debridement was 3 cm×4 cm~7 cm×9 cm.The first-stage operation was con-ducted to clean the wound.First the infected bone segments were removedThen the bone cement beads were implanted or the wound was covered by VSD and flap to prevent wound infection.During elective llizarov surgery,bone transport technology using an external fixator was performed after transporting or forcing bone segments to make defective bone repair and reconstruction.Variable parameters including the length of bone detect and the duration of carrying the exter-nal fixator were recorded.Then function of inj ured limb was evaluated by scoring.Results All the patients were fol-lowed up for 10~22 months with an average of 13.5 months.In 12 cases of patients with postoperative flaps survived more than 5 cases of free skin graft or wound.Tibial bone segment shifting or extension of the 6~10 cm,with an aver-age of 7 cm;external fixator carry time 7~1 6 months,the defect of the tibia were obtained reconstruction,with an aver-age of 1 1 months.According to Paley standard to evaluate bone lengthening bone removal and functional results,1 3 ca-ses were excellent,good in 3 cases,1 cases,the excellent rate was 94.1%.Conclusion Given the advantages of short treatment duration and less complication,bone transport with the llizarov method and assisted with an external fixator was recommended for treating patients with infected bone defects of the tibiaMeanwhile,this technique also had an ex-cellent outcome for limb reconstruction and deformity correction.Our results provided a reference for the clinical appli-cation of this technique.