Affiliation:
1. Department of Orthopaedics, Sir Ganga Ram Hospital, GRIPMER, New Delhi, India
2. Department of Orthopaedics, Military Hospital, Jammu, Jammu and Kashmir, India
3. Department of Orthopaedics, Indian Field Hospital Level II Plus, UNMISS, Juba, South Sudan
Abstract
Background:
Segmental bone loss in the femur and tibia is most often due to traumatic bone loss, resection of septic and aseptic nonunion, and resection of bone tumors. Reconstruction of these segmental defects incurs significant economic and social costs. The segmental bone defect has been treated with Masquelet’s induced membrane technique and bone transport using the Ilizarov circular external fixator and six-axis correction systems. Similarly, rail fixators for bone transport are an excellent and viable alternative for such cases.
Materials and Methods:
This ambispective observational study was done in 50 patients with segmental bone loss of the femur or tibia with a mean age of 34 years (range: 17–56 years) and operated with rail fixator application and underwent bone transport between January 2015 and October 2020. The functional and radiological outcomes were assessed. The outcomes were assessed using the Association for the Study and Application of the Methods of Ilizarov functional and bone criteria. The radiological outcomes were the bone healing index, distraction duration, and consolidation duration, which were assessed using regular postoperative radiographs.
Results:
The mean bone defect was 7.01 cm (range: 5–9.5 cm). The mean healing index was 35.92 days/cm. The mean distraction duration was 11.86 weeks (range: 7–24 weeks), and the mean consolidation duration was 22.94 weeks (range: 15–49 weeks). The mean time in the frame was 35.8 weeks (23–74 weeks). The most common complication was pin tract infection (12/50), followed by knee stiffness, ankle stiffness, and pin loosening. The functional results were excellent, good, and fair in 26, 22, and two patients, respectively. The bone results were excellent, good, and fair in 29, 17, and four patients, respectively.
Conclusion:
Segmental bone defects in the lower limb are difficult clinical scenarios to manage, which need a meticulous and deliberate approach while planning and execution of surgery. The surgical procedure of rail fixator application is simple; the learning curve is not steep, and patient acceptance is good with good to excellent functional and bone results.