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. 2022 May 19:9:858240.
doi: 10.3389/fsurg.2022.858240. eCollection 2022.

Bone Defects in Tibia Managed by the Bifocal vs. Trifocal Bone Transport Technique: A Retrospective Comparative Study

Alimujiang Abulaiti  1 , Yanshi Liu  1 , Feiyu Cai  1 , Kai Liu  1 , Abulaiti Abula  1 , Xiayimaierdan Maimaiti  1 , Peng Ren  1 , Aihemaitijiang Yusufu  1
Affiliations

Bone Defects in Tibia Managed by the Bifocal vs. Trifocal Bone Transport Technique: A Retrospective Comparative Study

Alimujiang Abulaiti et al. Front Surg. .

Abstract

Background: The purpose of this study is to evaluate the clinical effectiveness and determine the differences, if any, between the trifocal bone transport (TFT) technique and the bifocal bone transport (BFT) technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator.

Methods: A total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from the period January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8 ± 12.4 years (range 19-65 years). Out of these, 32 patients were treated by the BFT technique, and the remaining 21 patients were managed by the TFT technique. The demographic data, operation duration (OD), docking time (DT), external fixation time (EFT), and external fixation index (EFI) were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by following the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical visit.

Results: All patients achieved an infection-free union finally, and there was no significant difference between the two groups in terms of demographic data and both ASAMI bone and functional scores (p > 0.05). The mean defect size and OD in TFT (9.4 ± 1.5 cm, 161.9 ± 8.9 min) were larger than that in BFT (7.8 ± 1.8 cm, 122.5 ± 11.2 min) (p < 0.05). The mean DT, EFT, and EFI in TFT (65.9 ± 10.8 days, 328.0 ± 57.2 days, 34.8 ± 2.1 days/cm) were all less than those in BFT (96.8 ± 22.6 days, 474.5 ± 103.2 days, 60.8 ± 1.9 days/cm) (p < 0.05). Difficulties and complications were more prevalent in the BFT group than in the TFT group (p < 0.05).

Conclusion: Both the trifocal and BFT techniques achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. The TFT technique can significantly decrease the DT, EFT, EFI, difficulties, and complications compared with the BFT technique.

Keywords: bifocal bone transport; bone defect; distraction osteogenesis; reconstruction; trifocal bone transport.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic diagram of the two bone transport techniques for the management of the lower third bony segmental defects in the tibia (from left to right). (A) Bifocal bone transport technique. (B) Trifocal bone transport technique.
Figure 2
Figure 2
A 42-year-old man who suffered chronic osteomyelitis in his right tibia after internal fixation treatment followed by a road traffic accident and successfully treated by the bifocal bone transport (BFT) technique from proximal to distal. (A) Preoperative anteroposterior (AP) and lateral radiographs. (B) Preoperative general appearance, showing soft tissue defects with drainage and sinus. (C) AP and lateral radiographs immediately after radical debridement and installation of the monolateral external fixator; there were 6-cm bone defects. A BFT technique from proximal to distal was performed to reconstruct the injured limb.
Figure 3
Figure 3
Images of the same patient shown in Figure 2. (A) Radiographs reveal the complete consolidation and docking site union. (B) General appearance before frame removal, showing the satisfactory range of motion of knee and ankle joint results. (C) Radiographs 6 months later after removing the external fixator.
Figure 4
Figure 4
A 53-year-old man suffered chronic osteomyelitis in his right tibia after internal fixation treatment due to a crushing injury caused by a heavy object and was successfully managed by the trifocal bone transport technique (tandem transport, from proximal to distal). (A) Preoperative radiographs indicated that the infectious lesion was located at the distal one-third of the tibial shaft. (B) Removal of devitalized bone and soft tissue by radical debridement; the soft tissue defect was treated by using a local tissue flap. (C) There were 9-cm bone defects, and a trifocal tandem bone transport from proximal to distal was conducted for the limb reconstruction.
Figure 5
Figure 5
Images of the same patient shown in Figure 4. (A) Complete consolidation and docking site union after docking in 3 months. (B) Satisfactory functional recovery before monolateral external fixator removal. (C) Radiographs 9 months later after removing the frame.
See this image and copyright information in PMC

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