gms | German Medical Science

Questionnaire: Segmental bone transport anterograde or retrograde is a well-established method for tibial bone defect reconstruction to achieve bone continuity. Different external Fixations devices are in use. All external fixators are dealing with the problem of driving wires through the soft tissue when pulling the segment. The classic extramedullary cable transport is reducing the skin problem but is still cutting through the soft tissue. This is problematic after free flap soft tissue reconstruction. A new method is described of a complete intramedullary cable transport.

Methods: 15 Patients with a metaphyseal and diaphyseal bone defect of the tibia after open trauma and posttraumatic infection were treated with debridement, bone resection and soft tissue coverage by local and free flaps. After soft tissue healing the monolateral external fixation was replaced in each patient by a four ring ilizarov fixator with a proximal percutaneous tibia osteotomy. For bone transport a flexible cable was placed around the distal part of the segment and passed intramedullarly through the distal segment out of the tibia and on to the Ilizarov fixator and the transport clickers. The bone segment was transported after a delay of 7 days anterograd by the intramedullar placed cable one mm per day.

Results and Conclusions: In all patients the bone defect was closed by the bone transport. In one patient early consolidation of the regenerate occurred and a rupture of the cable. Two patients had an insufficiency of the callus. The distal docking site was augmented in all patients after the segment transport with iliac bone graft for consolidation. The one patient with early consolidation was treated by a second osteotomy; the two patients with insufficiency were augmented during the docking operation with iliac bone graft. The intramedullar cable transport is a new modification of the bone transport with the ilizarov ringfixator. The main advantage is the soft tissue spearing and protecting transport mechanism enabling bone transports after free flap soft tissue coverage with micro vascular anastomosis.