Pedicled Double-Barrel Fibular Transplantation Versus Bone Transport in the Treatment of Upper Tibial Osteomyelitis with Bone Defects: A Retrospective Study

Abstract

Objective: This study aimed to compare the clinical effects of using pedicled double-barrel fibular transplantation (PDBFT) and bone transport (BT) for the treatment of upper tibial osteomyelitis with bone defects.

Methods: A total of 83 patients with upper tibial osteomyelitis and bone defects were selected and retrospectively studied in Xi'an Hong Hui Hospital from January 2009 to January 2019. There were 52 males and 31 females, aged 19-72 years. The tibial defect range was 5-12 cm. Patients were divided into two groups, including the PDBFT (40 cases) and the BT group (43 cases). All patients were classified according to Cierny-Mader classification, including 48 cases of type III and 35 cases of type IV. Operation time, blood loss and cure time were compared. Ennecking score was used to evaluate limb functions, including pain, activity function, self-perception, brace use, walking ability, and gait change, while self-rating anxiety scale (SAS) was used for postoperative mental and psychological status. In addition, complications were recorded. All patients were followed for at least 2 years. SPSS 23.0 software was used to process data.

Results: There was no significant difference in demographic data between the two groups (p > 0.05). Operation time was 182.5 ± 22.7 min in PDBFT group vs, 124.2 ± 15.6 min in BT group, respectively (p < 0.05); intra-operative blood loss was 286 ± 34 ml vs 45 ± 18 ml (p < 0.05); cure time was 7.3 ± 1.8 months vs 11.6 ± 3.7 months (p < 0.05); and Ennecking score was 87.3% and 76.0%, respectively (p < 0.05). So, the PDBFT group showed longer operation time, more blood loss, shorter cure time, and better Ennecking score than the BT group. Importantly, limb functions of the PDBFT group were better than that of the BT group. Moreover, the PDBFT group presented better postoperative mental status and fewer complications than that in BT group (p < 0.05).

Conclusions: Patients were successfully cured by both the PDBFT and BT techniques. Compared with the BT group, the PDBFT group brought better clinical effects and fewer complications which could be the first operative choice for the treatment of upper tibial osteomyelitis with bone defects.

Keywords: bone defects; bone transport; double-barrel; fibular transplantation; tibial osteomyelitis.

Fig. 1

A 30‐year‐old male with infection and soft tissue defects after internal fixation of proximal tibial fracture. (A, B) Appearance before debridement; (C, D) X‐ray images of the proximal tibia before debridement; (E) After radical debridement, a large area of soft tissue and bone defects were left; (F) Appearance after transplantation of medial head of gastrocnemius muscle and skin grafting; (G, H) Postoperative X‐ray images showed that bone cement was filled into the proximal tibia

Fig. 2

The 30‐year‐old patient was treated by the PDBFT technique. (A) Six weeks after debridement, the wounds healed well; (B) During second operation, bone cement was removed from the medial incision of the proximal tibia; (C, D) Preoperative X‐ray images showed that the tibial defects were about 10 cm; (E, F) During operation, the ipsilateral pedicled fibula was made into a double‐barrel shape for transplantation; (G, H) X‐ray images after the PDBFT was performed; (I, J) One year after operation, the appearance of standing and squatting position; (K) One year after operation, the grafted fibula healed well. PDBFT stands for the pedicled double‐barrel fibular transplantation.

Fig. 3

The key surgical procedures of the PDBFT technique. (A) The ipsilateral pedicled fibular flap was cut and folded into two segments for pedicled transplantation; (B) The pedicled double‐barrel fibular flap was transplanted into the defect site of the upper tibia, the distal and proximal tibia were bridged by a locking plate.