J Korean Fract Soc.  2008 Jan;21(1):37-44. 10.12671/jkfs.2008.21.1.37.

Bone Transport Over the Intramedullary Nail for Defects of Long Bone

• Roh JY
• Oh CW
• Oh JK
• Kyung HS
• Park BC
• Min WK
• Kim JW
• Cho CH

• KMID: 1480962
• DOI: http://doi.org/10.12671/jkfs.2008.21.1.37

Abstract

PURPOSE: To evaluate the results of bone transport using external fixator over an intramedullary nail for defects of long bone.
MATERIALS AND METHODS
We treated 14 cases of bone defect after chronic osteomyelitis or trauma of tibia (12 cases) and femur (2 cases) using this method. The mean age of index procedure was 46.9 years, and all of them had follow-up study for a mean of 3 years. After the corticotomy and insertion of intramedullary nail, bone transport was done by external fixators. Then, the segment was moved and bone graft was done at docking site.
RESULTS
The mean transported amount was 5.8 cm, and the external fixator was removed after 141 days. The mean external fixation index was 25.6 days/cm. Primary union of distraction and docking site was achieved in all, but one had failure in union of docking site. According to the Mekhail's functional criteria, there were 5 excellent, 6 good, and 3 fair results. Among 15 complications, there were 2 major complications with residual sequelae, and they were 1 recurred osteomyelitis and 1 flexion contracture of knee.
CONCLUSION
Bone transport using external fixator over an intramedullary nail, can successfully solve defects of long bone. Since this method can remove external fixators earlier than the conventional method, it has fewer complications and makes patients to return to daily life earlier.

Keyword

Bone defect; External fixator; Intramedullary nail; Bone transport

MeSH Terms

Bone Nails
Contracture
External Fixators
Femur
Follow-Up Studies
Humans
Nails
Osteomyelitis
Tibia
Transplants

Figure

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  Fig. 1 (A) The patient had a large bone defect of 12 cm after the operation of tibial osteomyelitis. (B, C) With the insertion of intramedullary nail, ilizarov ring fixator was fixed to transport the distal segment.

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  Fig. 2 (A) After the transport, bone graft was done on the docking site with plate fixation. (B, C) At two years of follow-up, the tibia was well reconstructed without leg length discrepancy.

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  Fig. 3 (A) The patient showed a large tibial bone loss with the insertion of antibiotic cement-beads. (B, C) Proximal corticotomy was done for transport by the methods of external fixator over the intramedullary nail.

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  Fig. 4 (A) Bone graft was done on the docking site. (B) The distracted callus was good in consolidation at 3 month. (C) At the final follow-up, the tibia was well reconstructed.

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  Fig. 5 After the traumatic bone loss of the proximal tibia (A), external fixation was done over the intramedullary nail. Note the posterior angulation of proximal tibia (B). Bone transport was done from the distal fragment (C), and bone graft was made on the docking site.

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  Fig. 6 The external fixator was removed at 2 month after bone graft (A). At two years of follow-up, the tibia was well reconstructed. Although the knee joint shows procurvatum with anterior angulation of proximal tibia (B, C), the patient had a good functional outcome.

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