Abstract
Purpose: To assess the usefulness of Bone Transport and other “compression-distraction” systems for the treatment of Segmental Bone Defects (SBD) in patients younger than 16 years-old.
Patients and methods: This series includes 18 patients (12 boys, 6 girls) with SBD of the following etiologies: Post-traumatic defects with/without sepsis (14 cases) and post-resection defects (3 Congenital Pseudoartrosis of the Tibia -CPT- and 1 Aneurismal Bone Cyst). The age of the patients ranged from 8 to 16 years and the length of the defect from 5 cm to 13 cm except for one case (23 cm). The defect was located in the tibia in 14 cases and in the femur in four.
Nine patients (the longest defects) were treated by conventional Bone Transport whereas other compression-distraction techniques were used in the remaining. Monolateral frames were used in all cases. All but one of the post-traumatic cases had additional injuries and in four occasions one of the joints adjacent to the defect was involved.
Results: All cases healed, 6 with only one operation and 12 with more than one procedure. Healing time depended upon the length of the defect, age of the patient, etiology and occurrence of complications. Healing index also varied mainly depending on the etiology (CPT cases were slower) ranging form 1.5 to 0.7 months/cm. Bone graft at the compression site was used in 9 cases. Radiologically the most striking feature was the very early tubulization of the reconstructed segment along with the quick healing of the SBD.
The most frequent complication was pin tract infection (37%), one case needing change of pins. Fracture at the pin site was seen in two cases.
Functional results were closely related to: a. The healing of the defect and b. The existence of injuries to the joints adjacent to the defect.
With a minimum follow-up of 18 months there were 2 poor functional results due to an avascular necrosis of the dome of the talus (talus neck fracture).
Conclusion: These techniques are very useful in selected cases of large SBD in young patients. They have shown low morbidity, quick healing and, above all, very good remodeling potential. Associated injuries play a very important role in the final outcome of the treatment.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
