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. 2016:28:101-106.
doi: 10.1016/j.ijscr.2016.08.040. Epub 2016 Sep 3.

Ilizarov bone transport after massive tibial trauma: Case report

Nader S Alkenani  1 , Mariam A Alosfoor  2 , Abdulaziz K Al-Araifi  3 , Hala A Alnuaim  4
Affiliations

Ilizarov bone transport after massive tibial trauma: Case report

Nader S Alkenani et al. Int J Surg Case Rep. 2016.

Abstract

Introduction: This is a case report of extreme lengthening of the tibia of about 14.5cm using bone transport technique following road traffic accident trauma to the lower limbs. The management of the subsequent massive skeletal defects was challenging to orthopedic surgeons. Based on reported cases, the highest tibial lengthening was 22cm using bifocal transport, while the highest unifocal tibial lengthening reached 14.5cm.

Case presentation: A 20-year-old male driver was brought to the emergency department after a road traffic accident. The patient had a right Gustilo IIIA segmental open tibia fracture with bone loss and other severe injuries. The tibial defect was 14.5cm and the patient was then admitted for Ilizarov application six months after the accident. Although this case was particularly complicated, full limb length was restored.

Discussion: The management of this case was directed to correct the deformities and achieve equal length of both limbs to restore the normal function. Several new techniques have been developed recently to fill large bone defects. Limb lengthening using bone transport technique by application of Ilizarov ring fixator has been suggested as the leading option in filling massive bone gaps.

Conclusion: The use of bone transport technique using Ilizarov external rings has proved to be a minimally invasive and reliable method in managing massive bone defects. Accurate application of the Ilizarov frame and proper transport of the middle segment are important factors alleviating the risk for deviation of the transported segment. However, due to the need for regular follow-ups and monitoring, it demands high compliance from the patient to achieve optimal results.

Keywords: Bone lengthening; Distraction osteogenesis; Ilizarov technique.

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Figures

Fig. 1
Fig. 1
Preoperative X-ray on the admission day demonstrating the bone defect.
Fig. 2
Fig. 2
Corticotomy was performed and Ilizarov apparatus was applied.
Fig. 3
Fig. 3
Fine lines of regenerate formation.
Fig. 4
Fig. 4
X-ray demonstrating the regeneration after completing the distraction period.
Fig. 5
Fig. 5
Ilizarov frame removal after proper consolidation with partial union at docking site.
Fig. 6
Fig. 6
X-ray demonstrates internal fixation and MIPO of docking site.
Fig. 7
Fig. 7
Docking site compression with two rings to manage the nonunion.
Fig. 8
Fig. 8
The final x-ray with full weight-bearing.
See this image and copyright information in PMC

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