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. 2022 Apr 10;17(1):219.
doi: 10.1186/s13018-022-03109-1.

Acute shortening and re-lengthening versus antibiotic calcium sulfate-loaded bone transport for the management of large segmental tibial defects after trauma

Qiang Huang #  1 , YiBo Xu #  1 , Yao Lu #  1 , Cheng Ren  1 , Lu Liu  1 , Ming Li  1 , Qian Wang  1 , Zhong Li  1 , HanZhong Xue  1 , Kun Zhang  2 , Teng Ma  3
Affiliations

Acute shortening and re-lengthening versus antibiotic calcium sulfate-loaded bone transport for the management of large segmental tibial defects after trauma

Qiang Huang et al. J Orthop Surg Res. .

Abstract

Background: The purpose of this paper was to compare the clinical effects of acute shortening and re-lengthening (ASR) technique with antibiotic calcium sulfate-loaded bone transport (ACSBT) technique for the management of large segmental tibial defects after trauma.

Methods: In this retrospective study, 68 patients with large segmental tibial defects were included and completely followed. The bone loss was 3-10 cm. ASR group included 32 patients, while ACSBT group contained 36. There was no significant difference in demographic information between the two groups. The external fixation time (EFT) and external fixation index (EFI) were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification.

Results: The mean EFT was 9.2 ± 1.8 months in ASR group and 10.1 ± 2.0 months in ACSBT group, respectively. The mean EFI was 1.5 ± 0.2 month/cm and 1.4 ± 0.3 month/cm. According to the ASAMI criteria, in ASR group bone defect healing was excellent in 22 cases, good in 7 cases and fair in 3 cases. In ACSBT group, it was excellent in 23 cases, good in 11 cases and fair in 2 cases. In ASR group, the limb function was excellent in 15 cases, good in 7 cases and fair in 10 cases, while it was excellent in 14 cases, good in 9 cases and fair in 13 cases with ACSBT group. There was no significant difference in EFI, bone defect healing and limb functions between the two groups (p > 0.05). The mean number of complications per patient in ACSBT group was significantly lower than that in ASR group (p < 0.05).

Conclusion: Both techniques can be successfully used for the management of large segmental tibial defects after trauma. There was no significant difference in EFI, limb functions and bone defect healing between the two groups. Compared with ASR group, the complication incidence in ACSBT group was lower, especially the infection-related complications. Therefore, for patients with large segmental bone defects caused by infection or osteomyelitis, ACSBT technique could be the first choice.

Keywords: Acute shortening; Bone transport; Calcium sulfate; Tibial defect.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A 30-year-old male was successfully treated by ASR technique. a The patient suffered from a severe open fracture of the tibia; b after thorough debridement, acute shortening and temporary external fixation were performed. The tibial defects were 7.5 cm; c, d the Ilizarov annular lengthening frame was installed, and osteotomy was performed; e, f bone lengthening was successfully applied to restore the limb length; g, h X-ray images after removing the external frame; and i–k X-ray images at one year after removing the annular frame. ASR stands for acute shortening and re-lengthening
Fig. 2
Fig. 2
A 52-year-old male was successfully treated by ACSBT technique. a, b The patient suffered from a severe open fracture and infection of the tibia; c, d after thorough debridement, bone cement was filled into the bone defect site. The tibial defects were 9.0 cm; e, f the Ilizarov annular transport frame was installed, and antibiotic-loaded calcium sulfate was inserted; g–j ACSBT technique was successfully applied to repair the tibial defects; and k, l X-ray images at one year after removing the annular frame. ACSBT stands for antibiotic calcium sulfate-loaded bone transport
See this image and copyright information in PMC

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