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

• DOI: 10.1007/s11999-015-4326-6
• Publication Date: 2015-05-04T13:39:50Z
• Authors: Mitchell Bernstein; Austin T. Fragomen; Samir Sabharwal; Jonathan Barclay; S. Robert Rozbruch
• Keywords: Ilizarov Technique

Limb salvage in the presence of posttraumatic tibial bone loss can be accomplished using traditional Ilizarov method distraction osteogenesis with circular external fixation. Internal fixation placed at beginning consolidation phase, so-called integrated fixation, may allow for earlier removal fixator but introduces concerns about cross-contamination from additional open procedure and maintenance regenerate stability. Among patients deemed eligible we sought to determine: (1) Does decrease time fixator? (2) Is there a difference rate complications between two groups? (3) Are differences functional radiographic results approach alone? Between January 2006 December 2012, treated 58 (58 tibiae) method. Of those, 30 (52%) were "classic technique" (external alone) 28 (48%) "integrated (a combination an plating or insertion intramedullary nail). During that period, general indications use technique closed physes, no active infection, healed soft tissue envelope located intended internal site; remainder classic technique. Followup on (100%) techniques, respectively, was achieved minimum 1 year (mean, 3 years; range, 1–8 years). Adverse events reported as problems, obstacles, according publication by Paley. Problems obstacles are managed nonoperative operative means, respectively; addition, they resolve completely treatment. Complications, Paley classification, result permanent sequelae. Functional Association Study Application Methods scoring system. Overall, mean four (range, 2–5) surgical procedures complete reconstruction similar incidence unplanned (obstacles) groups (p = 0.87). Patients spent less fixator, 7 months 5–20 months) versus 11 1–15 months; p < 0.001). There seven 15 zero group. Ten one complication occurred severity 0.87) number 0.40) both groups. Good excellent function scores obtained 100% 98% patients, respectively. The allows more efficient limb carefully selected approach, whereas frequency adverse ability restore lengths not different numbers available. Careful placement pins is critical planned constructs. In this study defect reconstruction, good/excellent found all after procedures; however, larger multicenter prospective would robust generalizable conclusions. Level III, therapeutic study.