Abstract
Tibial fractures complicated by bone and/or soft tissue loss present a great challenge. Traditional methods of limb reconstruction are lengthy and may not yield satisfactory functional results. Despite its tremendous contribution to the management of this condition, the Ilizarov technique of bone transport has several problems and difficulties.
The present study was carried out between 1997 and 2002 and included 21 patients with tibial fractures complicated by bone and soft tissue defects as a result of open fractures or surgical debridement of infected non-unions. The bone loss ranged from three to eleven cm. (average 4.7 cm.). Ages ranged from 12 to 54 years (average 28.8 years). The follow-up ranged from 24 to 75 months. The procedure included resection of all devitalised tissues, acute limb shortening to close the defect, application of the external fixator and metaphyseal osteotomy for re-lengthening.
In all patients the fractures united with well aligned limbs. Acute limb shortening of up to six cm. was done in the lower third of the leg. Limb lengthening was done in all cases and ranged from 3 to 9.5 cm. (average 4 cm.). An Ilizarov external fixator was used in nine cases (41%) and a monolateral fixator in 13 cases (59%) with a total of 22 applications. Residual leg length discrepancy of more than 3cm. occurred in four cases (19%). Complications included one refracture, one transient peroneal nerve palsy and one equinus contracture of ten degrees. Satisfactory results were obtained in 93% of cases.
Acute limb shortening and re-lengthening converts a complicated limb reconstruction into a relatively simpler one of linear limb lengthening, without the difficulties of traditional Ilizarov techniques and eliminated the need for soft tissue flaps. It is better instituted early in the management of these cases to ensure better functional results and shorter treatment time.
