Tibial Bone Loss: How to Treat without Circular Fixation?
Abstract
Segmental tibial bone defects (STBD) represent a dilemma for the trauma surgeon; these defects could result from trauma, after debridement for infection, or after tumor resection. We aimed in this review to shed some light on the various reconstruction options without the need to use a circular fixator. Reconstruction options rely on various factors related to the patient, the surgeon, and the nature of the defect (location and size). Various reconstruction techniques include simple bone grafting (autograft or allografts), bone transport [distraction osteogenesis (DO)], induced membrane technique, and vascularized fibular graft. Fixation could be performed using either internal or external fixators; the latter could be a circular or a unilateral frame. Although circular frames (Ilizarov) fixators reported good results, they are still considered cumbersome, need special attention, carry pin tract infection risk, and could not be tolerated by patients. Hence, various other options were introduced, such as bone transport over an intramedullary nail (IMN), rail monolateral external fixator, and tibialisation of the ipsilateral fibula.
1. Eralp L, Kocaoglu M, Polat G, Bas A, Dirican A, Azam ME. A comparison of external fixation alone or combined with intramedullary nailing in the treatment of segmental tibial defects. Acta Orthop Belg. 2012;78(5):652-9. [PubMed: 23162962].
2. Lu Y, Ma T, Ren C, Li Z, Sun L, Xue H, et al. Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate. J Int Med Res.
2020;48(4):300060520920407. doi: 10.1177/0300060520920407.
[PubMed: 32351151]. [PubMed Central: PMC7218946].
3. Borzunov DY, Balaev PI, Subramanyam KN. Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients. Indian J Orthop. 2015;49(5): 516-22. doi: 10.4103/0019-5413.164042. [PubMed: 26538757]. [PubMed Central: PMC4598542].
4. Nauth A, McKee MD, Einhorn TA, Watson JT, Li R, Schemitsch EH. Managing bone defects. J Orthop Trauma. 2011;25(8):462-6. doi: 10.1097/BOT.0b013e318224caf0. [PubMed: 21738065].
5. Amoozadeh Omrani F, Elahi M, Sarzaeem MM, Sayadi S, Farzaneh H. Infection rate of reamed versus unreamed intramedullary nailing in open tibia fractures. J Orthop Spine Trauma. 2020;5(2):29-31. doi: 10.18502/jost.v5i2.3749.
6. Klifto KM, Azoury SC, Klifto CS, Mehta S, Levin LS, Kovach SJ. Treatment of posttraumatic tibial diaphyseal bone defects: A systematic review and meta-analysis. J Orthop Trauma.
2022;36(2):55-64.doi:10.1097/BOT.0000000000002214.
[PubMed: 34633778].
7. McClure PK, Abouei M, Conway JD. Reconstructive options for tibial bone defects. J Am Acad Orthop Surg. 2021;29(21):901-9. doi: 10.5435/JAAOS-D-21-00049. [PubMed: 34288887].
8. Mudiganty S, Daolagupu AK, Sipani AK, Das SK, Dhar A, Gogoi PJ. Treatment of infected non-unions with segmental defects with a rail fixation system. Strategies Trauma Limb Reconstr. 2017;12(1):45-51. doi: 10.1007/s11751-017-0278-6. [PubMed: 28236034]. [PubMed Central: PMC5360676].
9. Grivas TB, Magnissalis EA. The use of twin-ring Ilizarov external fixator constructs: application and biomechanical proof-of principle with possible clinical indications. J Orthop Surg Res. 2011;6:41. doi: 10.1186/1749-799X-6-41. [PubMed: 21834985]. [PubMed Central: PMC3178515].
10. Moss DP, Tejwani NC. Biomechanics of external fixation: A review of the literature. Bull NYU Hosp Jt Dis. 2007;65(4):294-9. [PubMed: 18081548].
11. McClure PK, Alrabai HM, Conway JD. Preoperative evaluation and optimization for reconstruction of segmental bone defects of the tibia. J Orthop Trauma. 2017;31(Suppl 5):S16-S19. doi: 10.1097/BOT.0000000000000983. [PubMed: 28938385].
12. Brinker MR, O'Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma. 2007;21(8):557-70. doi: 10.1097/BOT.0b013e31814d4dc6. [PubMed: 17805023].
13. Richard HM, Nguyen DC, Birch JG, Roland SD, Samchukov MK, Cherkashin AM. Clinical implications of psychosocial factors on pediatric external fixation treatment and recommendations. Clin Orthop Relat Res. 2015;473(10):3154-62. doi: 10.1007/s11999-015-4276-z. [PubMed: 25828943]. [PubMed Central: PMC4562937].
14. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347(24):1924-31. doi: 10.1056/NEJMoa012604. [PubMed: 12477942].
15. Bezstarosti H, Metsemakers WJ, van Lieshout EMM, Voskamp LW, Kortram K, McNally MA, et al. Management of critical-sized bone defects in the treatment of fracture-related infection: A systematic review and pooled analysis. Arch Orthop Trauma Surg. 2021;141(7):1215-30. doi: 10.1007/s00402-020-03525-0. [PubMed: 32860565]. [PubMed Central: PMC8215045].
16. Sanders DW, Bhandari M, Guyatt G, Heels-Ansdell D, Schemitsch EH, Swiontkowski M, et al. Critical-sized defect in the tibia: Is it critical? Results from the SPRINT trial. J Orthop Trauma. 2014;28(11):632-5. doi: 10.1097/BOT.0000000000000194. [PubMed: 25233157].
17. Schemitsch EH. Size matters: Defining critical in bone defect size! J Orthop Trauma. 2017;31(Suppl 5):S20-S22. doi: 10.1097/BOT.0000000000000978. [PubMed: 28938386].
18. Court-Brown CM, Keating JF, Christie J, McQueen MM. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg Br. 1995;77(3):407-11. [PubMed: 7744925].
19. Bhandari M, Guyatt G, Tornetta P, III, Schemitsch EH, Swiontkowski M, Sanders D, et al. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures.
J Bone Joint Surg Am. 2008;90(12):2567-78. doi:
10.2106/JBJS.G.01694. [PubMed: 19047701]. [PubMed Central:
PMC2663330].
20. Obremskey W, Molina C, Collinge C, Tornetta P 3rd, Sagi C, Schmidt A, et al. Current practice in the management of open fractures among orthopaedic trauma surgeons. Part B: Management of segmental long bone defects. A survey of Orthopaedic Trauma Association members. J Orthop Trauma. 2014;28(8):e203-e207. doi: 10.1097/BOT.0000000000000034. [PubMed: 26057886].
21. Bucholz RW, Heckman JD, Tornetta P, McQueen MM, Ricci WM. Rockwood and Green's fractures in adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. p. 1275.
22. Nauth A, Schemitsch E, Norris B, Nollin Z, Watson JT. Critical-size bone defects: is there a consensus for diagnosis and treatment? J Orthop Trauma. 2018;32(Suppl 1):S7-S11. doi: 10.1097/BOT.0000000000001115. [PubMed: 29461395].
23. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am. 2010;41(1):27-37. doi: 10.1016/j.ocl.2009.07.011. [PubMed: 19931050].
24. Canale ST, Beaty JH. Campbell's operative orthopaedics e-book: Expert consult premium edition - Enhanced online features. Philadelphia, PA: Elsevier/Mosby; 2012.
25. Hernigou P, Poignard A, Beaujean F, Rouard H. Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells. J Bone Joint Surg Am. 2005;87(7):1430-7. doi: 10.2106/JBJS.D.02215. [PubMed: 15995108].
26. Jager M, Jelinek EM, Wess KM, Scharfstadt A, Jacobson M, Kevy SV, et al. Bone marrow concentrate: A novel strategy for bone defect treatment. Curr Stem Cell Res Ther. 2009;4(1):34-43. doi: 10.2174/157488809787169039. [PubMed: 19149628].
27. Pelissier P, Masquelet AC, Bareille R, Pelissier SM, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res. 2004;22(1):73-9. doi: 10.1016/S0736-0266(03)00165-7. [PubMed: 14656662].
28. Canavese F, Khan A. Chronic osteomyelitis in children treated with antibiotic-laden cement: A preliminary report. J Orthop Spine Trauma. 2016;2(2):e5283. doi: 10.17795/jost-5283.
29. Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res. 2012;98(1): 97-102. doi: 10.1016/j.otsr.2011.11.001. [PubMed: 22244249].
30. Morris R, Hossain M, Evans A, Pallister I. Induced membrane technique for treating tibial defects gives mixed results. Bone Joint J. 2017;99-B(5):680-5. doi: 10.1302/0301-620X.99B5.BJJ-2016-0694.R2. [PubMed: 28455479].
31. Sagi HC, Young ML, Gerstenfeld L, Einhorn TA, Tornetta P. Qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient. J Bone Joint Surg Am. 2012;94(23):2128-35. doi: 10.2106/JBJS.L.00159. [PubMed: 23224383].
32. Dawson J, Kiner D, Gardner W, Swafford R, Nowotarski PJ. The reamer-irrigator-aspirator as a device for harvesting bone graft compared with iliac crest bone graft: Union rates and complications. J Orthop Trauma. 2014;28(10):584-90. doi: 10.1097/BOT.0000000000000086. [PubMed: 24625833].
33. Stafford PR, Norris BL. Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: A review of 25 cases. Injury. 2010;41(Suppl 2): S72-S77. doi: 10.1016/S0020-1383(10)70014-0. [PubMed: 21144933].
34. Attias N, Thabet AM, Prabhakar G, Dollahite JA, Gehlert RJ, DeCoster TA. Management of extra-articular segmental defects in long bone using a titanium mesh cage as an adjunct to other methods of fixation: A multicentre report of 17 cases. Bone Joint J. 2018;100-B(5):646-51. doi: 10.1302/0301-
620X.100B5.BJJ-2017-0817.R2. [PubMed: 29701099].
35. Cobos JA, Lindsey RW, Gugala Z. The cylindrical titanium mesh cage for treatment of a long bone segmental defect: Description of a new technique and report of two cases. J Orthop Trauma. 2000;14(1):54-9. doi: 10.1097/00005131-200001000-00011. [PubMed: 10630804].
36. Mekhail AO, Abraham E, Gruber B, Gonzalez M. Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma. 2004;56(2):368-78. doi: 10.1097/01.TA.0000057234.48501.30. [PubMed: 14960982].
37. Bernstein M, Fragomen AT, Sabharwal S, Barclay J, Rozbruch SR. Does integrated fixation provide benefit in the reconstruction of posttraumatic tibial bone defects? Clin Orthop Relat Res. 2015;473(10):3143-53. doi: 10.1007/s11999-015-4326-6. [PubMed: 25940337] [PubMed Central: PMC4562932].
38. Yin P, Zhang L, Zhang L, Li T, Li Z, Li J, et al. Ilizarov bone transport for the treatment of fibular osteomyelitis: A report of five cases. BMC Musculoskelet Disord. 2015;16:242. doi: 10.1186/s12891-015-0708-x. [PubMed: 26342841]. [PubMed Central: PMC4561167].
39. Bhardwaj R, Singh J, Kapila R, Boparai RS. Comparision of ilizarov ring fixator and rail fixator in infected nonunion of long bones: A retrospective followup study. Indian J Orthop. 2019;53(1):82-8. doi: 10.4103/ortho.IJOrtho_77_17. [PubMed: 30905986]. [PubMed Central: PMC6394165].
40. Bas A, Daldal F, Eralp L, Kocaoglu M, Uludag S, Sari S. Treatment of tibial and femoral bone defects with bone transport over an intramedullary nail. J Orthop Trauma. 2020;34(10):e353-e359. doi: 10.1097/BOT.0000000000001780. [PubMed: 32304473].
41. Olesen UK, Nygaard T, Prince DE, Gardner MP, Singh UM, McNally MA, et al. Plate-assisted bone segment transport with motorized lengthening nails and locking plates: A technique to treat femoral and tibial bone defects. J Am Acad Orthop Surg Glob Res Rev. 2019;3(8):e064. doi: 10.5435/JAAOSGlobal-D-19-00064. [PubMed: 31592010]. [PubMed Central: PMC6754216].
42. Girard PJ, Kuhn KM, Bailey JR, Lynott JA, Mazurek MT. Bone
transport combined with locking bridge plate fixation for the treatment of tibial segmental defects: A report of 2 cases. J
Orthop Trauma. 2013;27(9):e220-e226. doi:
10.1097/BOT.0b013e31827069b9. [PubMed: 22955338].
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48. Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am. 1980;62(7):1039-58. [PubMed: 7000788].
2. Lu Y, Ma T, Ren C, Li Z, Sun L, Xue H, et al. Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate. J Int Med Res.
2020;48(4):300060520920407. doi: 10.1177/0300060520920407.
[PubMed: 32351151]. [PubMed Central: PMC7218946].
3. Borzunov DY, Balaev PI, Subramanyam KN. Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients. Indian J Orthop. 2015;49(5): 516-22. doi: 10.4103/0019-5413.164042. [PubMed: 26538757]. [PubMed Central: PMC4598542].
4. Nauth A, McKee MD, Einhorn TA, Watson JT, Li R, Schemitsch EH. Managing bone defects. J Orthop Trauma. 2011;25(8):462-6. doi: 10.1097/BOT.0b013e318224caf0. [PubMed: 21738065].
5. Amoozadeh Omrani F, Elahi M, Sarzaeem MM, Sayadi S, Farzaneh H. Infection rate of reamed versus unreamed intramedullary nailing in open tibia fractures. J Orthop Spine Trauma. 2020;5(2):29-31. doi: 10.18502/jost.v5i2.3749.
6. Klifto KM, Azoury SC, Klifto CS, Mehta S, Levin LS, Kovach SJ. Treatment of posttraumatic tibial diaphyseal bone defects: A systematic review and meta-analysis. J Orthop Trauma.
2022;36(2):55-64.doi:10.1097/BOT.0000000000002214.
[PubMed: 34633778].
7. McClure PK, Abouei M, Conway JD. Reconstructive options for tibial bone defects. J Am Acad Orthop Surg. 2021;29(21):901-9. doi: 10.5435/JAAOS-D-21-00049. [PubMed: 34288887].
8. Mudiganty S, Daolagupu AK, Sipani AK, Das SK, Dhar A, Gogoi PJ. Treatment of infected non-unions with segmental defects with a rail fixation system. Strategies Trauma Limb Reconstr. 2017;12(1):45-51. doi: 10.1007/s11751-017-0278-6. [PubMed: 28236034]. [PubMed Central: PMC5360676].
9. Grivas TB, Magnissalis EA. The use of twin-ring Ilizarov external fixator constructs: application and biomechanical proof-of principle with possible clinical indications. J Orthop Surg Res. 2011;6:41. doi: 10.1186/1749-799X-6-41. [PubMed: 21834985]. [PubMed Central: PMC3178515].
10. Moss DP, Tejwani NC. Biomechanics of external fixation: A review of the literature. Bull NYU Hosp Jt Dis. 2007;65(4):294-9. [PubMed: 18081548].
11. McClure PK, Alrabai HM, Conway JD. Preoperative evaluation and optimization for reconstruction of segmental bone defects of the tibia. J Orthop Trauma. 2017;31(Suppl 5):S16-S19. doi: 10.1097/BOT.0000000000000983. [PubMed: 28938385].
12. Brinker MR, O'Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma. 2007;21(8):557-70. doi: 10.1097/BOT.0b013e31814d4dc6. [PubMed: 17805023].
13. Richard HM, Nguyen DC, Birch JG, Roland SD, Samchukov MK, Cherkashin AM. Clinical implications of psychosocial factors on pediatric external fixation treatment and recommendations. Clin Orthop Relat Res. 2015;473(10):3154-62. doi: 10.1007/s11999-015-4276-z. [PubMed: 25828943]. [PubMed Central: PMC4562937].
14. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347(24):1924-31. doi: 10.1056/NEJMoa012604. [PubMed: 12477942].
15. Bezstarosti H, Metsemakers WJ, van Lieshout EMM, Voskamp LW, Kortram K, McNally MA, et al. Management of critical-sized bone defects in the treatment of fracture-related infection: A systematic review and pooled analysis. Arch Orthop Trauma Surg. 2021;141(7):1215-30. doi: 10.1007/s00402-020-03525-0. [PubMed: 32860565]. [PubMed Central: PMC8215045].
16. Sanders DW, Bhandari M, Guyatt G, Heels-Ansdell D, Schemitsch EH, Swiontkowski M, et al. Critical-sized defect in the tibia: Is it critical? Results from the SPRINT trial. J Orthop Trauma. 2014;28(11):632-5. doi: 10.1097/BOT.0000000000000194. [PubMed: 25233157].
17. Schemitsch EH. Size matters: Defining critical in bone defect size! J Orthop Trauma. 2017;31(Suppl 5):S20-S22. doi: 10.1097/BOT.0000000000000978. [PubMed: 28938386].
18. Court-Brown CM, Keating JF, Christie J, McQueen MM. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg Br. 1995;77(3):407-11. [PubMed: 7744925].
19. Bhandari M, Guyatt G, Tornetta P, III, Schemitsch EH, Swiontkowski M, Sanders D, et al. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures.
J Bone Joint Surg Am. 2008;90(12):2567-78. doi:
10.2106/JBJS.G.01694. [PubMed: 19047701]. [PubMed Central:
PMC2663330].
20. Obremskey W, Molina C, Collinge C, Tornetta P 3rd, Sagi C, Schmidt A, et al. Current practice in the management of open fractures among orthopaedic trauma surgeons. Part B: Management of segmental long bone defects. A survey of Orthopaedic Trauma Association members. J Orthop Trauma. 2014;28(8):e203-e207. doi: 10.1097/BOT.0000000000000034. [PubMed: 26057886].
21. Bucholz RW, Heckman JD, Tornetta P, McQueen MM, Ricci WM. Rockwood and Green's fractures in adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. p. 1275.
22. Nauth A, Schemitsch E, Norris B, Nollin Z, Watson JT. Critical-size bone defects: is there a consensus for diagnosis and treatment? J Orthop Trauma. 2018;32(Suppl 1):S7-S11. doi: 10.1097/BOT.0000000000001115. [PubMed: 29461395].
23. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am. 2010;41(1):27-37. doi: 10.1016/j.ocl.2009.07.011. [PubMed: 19931050].
24. Canale ST, Beaty JH. Campbell's operative orthopaedics e-book: Expert consult premium edition - Enhanced online features. Philadelphia, PA: Elsevier/Mosby; 2012.
25. Hernigou P, Poignard A, Beaujean F, Rouard H. Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells. J Bone Joint Surg Am. 2005;87(7):1430-7. doi: 10.2106/JBJS.D.02215. [PubMed: 15995108].
26. Jager M, Jelinek EM, Wess KM, Scharfstadt A, Jacobson M, Kevy SV, et al. Bone marrow concentrate: A novel strategy for bone defect treatment. Curr Stem Cell Res Ther. 2009;4(1):34-43. doi: 10.2174/157488809787169039. [PubMed: 19149628].
27. Pelissier P, Masquelet AC, Bareille R, Pelissier SM, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res. 2004;22(1):73-9. doi: 10.1016/S0736-0266(03)00165-7. [PubMed: 14656662].
28. Canavese F, Khan A. Chronic osteomyelitis in children treated with antibiotic-laden cement: A preliminary report. J Orthop Spine Trauma. 2016;2(2):e5283. doi: 10.17795/jost-5283.
29. Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res. 2012;98(1): 97-102. doi: 10.1016/j.otsr.2011.11.001. [PubMed: 22244249].
30. Morris R, Hossain M, Evans A, Pallister I. Induced membrane technique for treating tibial defects gives mixed results. Bone Joint J. 2017;99-B(5):680-5. doi: 10.1302/0301-620X.99B5.BJJ-2016-0694.R2. [PubMed: 28455479].
31. Sagi HC, Young ML, Gerstenfeld L, Einhorn TA, Tornetta P. Qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient. J Bone Joint Surg Am. 2012;94(23):2128-35. doi: 10.2106/JBJS.L.00159. [PubMed: 23224383].
32. Dawson J, Kiner D, Gardner W, Swafford R, Nowotarski PJ. The reamer-irrigator-aspirator as a device for harvesting bone graft compared with iliac crest bone graft: Union rates and complications. J Orthop Trauma. 2014;28(10):584-90. doi: 10.1097/BOT.0000000000000086. [PubMed: 24625833].
33. Stafford PR, Norris BL. Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: A review of 25 cases. Injury. 2010;41(Suppl 2): S72-S77. doi: 10.1016/S0020-1383(10)70014-0. [PubMed: 21144933].
34. Attias N, Thabet AM, Prabhakar G, Dollahite JA, Gehlert RJ, DeCoster TA. Management of extra-articular segmental defects in long bone using a titanium mesh cage as an adjunct to other methods of fixation: A multicentre report of 17 cases. Bone Joint J. 2018;100-B(5):646-51. doi: 10.1302/0301-
620X.100B5.BJJ-2017-0817.R2. [PubMed: 29701099].
35. Cobos JA, Lindsey RW, Gugala Z. The cylindrical titanium mesh cage for treatment of a long bone segmental defect: Description of a new technique and report of two cases. J Orthop Trauma. 2000;14(1):54-9. doi: 10.1097/00005131-200001000-00011. [PubMed: 10630804].
36. Mekhail AO, Abraham E, Gruber B, Gonzalez M. Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma. 2004;56(2):368-78. doi: 10.1097/01.TA.0000057234.48501.30. [PubMed: 14960982].
37. Bernstein M, Fragomen AT, Sabharwal S, Barclay J, Rozbruch SR. Does integrated fixation provide benefit in the reconstruction of posttraumatic tibial bone defects? Clin Orthop Relat Res. 2015;473(10):3143-53. doi: 10.1007/s11999-015-4326-6. [PubMed: 25940337] [PubMed Central: PMC4562932].
38. Yin P, Zhang L, Zhang L, Li T, Li Z, Li J, et al. Ilizarov bone transport for the treatment of fibular osteomyelitis: A report of five cases. BMC Musculoskelet Disord. 2015;16:242. doi: 10.1186/s12891-015-0708-x. [PubMed: 26342841]. [PubMed Central: PMC4561167].
39. Bhardwaj R, Singh J, Kapila R, Boparai RS. Comparision of ilizarov ring fixator and rail fixator in infected nonunion of long bones: A retrospective followup study. Indian J Orthop. 2019;53(1):82-8. doi: 10.4103/ortho.IJOrtho_77_17. [PubMed: 30905986]. [PubMed Central: PMC6394165].
40. Bas A, Daldal F, Eralp L, Kocaoglu M, Uludag S, Sari S. Treatment of tibial and femoral bone defects with bone transport over an intramedullary nail. J Orthop Trauma. 2020;34(10):e353-e359. doi: 10.1097/BOT.0000000000001780. [PubMed: 32304473].
41. Olesen UK, Nygaard T, Prince DE, Gardner MP, Singh UM, McNally MA, et al. Plate-assisted bone segment transport with motorized lengthening nails and locking plates: A technique to treat femoral and tibial bone defects. J Am Acad Orthop Surg Glob Res Rev. 2019;3(8):e064. doi: 10.5435/JAAOSGlobal-D-19-00064. [PubMed: 31592010]. [PubMed Central: PMC6754216].
42. Girard PJ, Kuhn KM, Bailey JR, Lynott JA, Mazurek MT. Bone
transport combined with locking bridge plate fixation for the treatment of tibial segmental defects: A report of 2 cases. J
Orthop Trauma. 2013;27(9):e220-e226. doi:
10.1097/BOT.0b013e31827069b9. [PubMed: 22955338].
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| Files | ||
| Issue | Vol 9, No 1 (2023) | |
| Section | Review Article | |
| DOI | https://doi.org/10.18502/jost.v9i1.12561 | |
| Keywords | ||
| Tibia Bone Loss Reconstruction Ilizarov Technique | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Farouk O, Khalifa A. Tibial Bone Loss: How to Treat without Circular Fixation?. J Orthop Spine Trauma. 2023;9(1):1-5.
