Treatment of Large Femoral and Tibial Bone Defects With Plate-Assisted Bone Segment Transport

Abstract

Objectives: The purposes of this study were to assess clinical and radiographic outcomes following plate-assisted bone segment transport (PABST) in large bone defects of the lower extremities.

Design: Retrospective study of prospectively collected data.

Setting: Level-1 trauma center located in Germany.

Patient selection criteria: Patients who underwent PABST and were at least 1 year postoperatively were included.

Outcome measures and comparisons: Demographic data were collected. Radiographic apparent bone gap (RABG), time to consolidation, time to full weight-bearing, and consolidation index were calculated. Numeric rating scale, lower extremity functional scale (LEFS), and complications were assessed.

Results: Fifteen patients [13 male; mean age 51 years (range, 20-75)] underwent PABST and had follow-up at a mean of 29.1 months. The tibia was affected in 8 and the femur in 7 patients. Preoperative RABG was 60 mm [interquartile range (IQR): 40-125], and bone defects were caused by septic nonunions in 73% of patients. Fourteen patients (93%) demonstrated consolidated transport callus at 7.3 months [95% confidence interval (95% CI), 6-8.5], and 9 patients (60%) demonstrated complete consolidation of both docking site and transport callus at 11.5 months (95% CI, 7.3-15.3). Postoperative RABG was 0.1 mm (IQR: 0-0.8), and consolidation index was 1.9 months/cm (95% CI, 1.3-2.5). All patients achieved full weight-bearing at 8.7 months (IQR: 6.5-10.3). LEFS was 42 (95% CI, 34-50), and numeric rating scale was 3 (95% CI, 2-4). Patients treated for tibial defects had a significantly higher consolidation rate compared with patients treated for femoral defects ( P = 0.040).

Conclusions: PABST demonstrated high consolidation of transport callus with few complications. Although full weight-bearing was achieved in all patients, complete consolidation of the docking site was only present in 60% of cases.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

FIGURE 1.

Radiographic images during the PABST procedure of the tibia. A, A 20-year-old man with nonunion following multiple revisions after a pathologic fracture of the lower leg associated with a juvenile bone cyst 6 years ago. B, PABST procedure after resection of the nonunion. C, Before (left image) and after (right image) docking site procedure with autologous bone graft. D, Radiographic follow-up 1 year after PABST procedure demonstrating complete consolidation.

FIGURE 2.

Radiographic images during the PABST procedure of the femur. A, A 53-year-old man following debridement and placement of an antibiotic spacer for septic nonunion. The patient had multiple operative revisions after having sustained a closed comminuted femoral fracture as a result of a motorcycle accident. B, Immediate postoperative radiograph following PABST. C, Radiographs demonstrating completed segment transport. D, Radiographs at 20 months postoperatively following removal of Precice nail, reosteosynthesis, and docking site procedure demonstrating complete consolidation of the docking site and transport callus.