Although gradual bone transport may permit the
restoration of large-diameter bones, complications are common owing
to the long duration of external fixation. In order to reduce such
complications, a new technique of bone transport involving the use
of an external fixator and a locking plate was devised for segmental
tibial bone defects. A total of ten patients (nine men, one woman) with a mean age
at operation of 40.4 years (16 to 64) underwent distraction osteogenesis
with a locking plate to treat previously infected post-traumatic
segmental tibial defects. The locking plate was fixed percutaneously
to bridge proximal and distal segments, and was followed by external fixation.
After docking, percutaneous screws were fixed at the transported
segment through plate holes. At the same time, bone grafting was
performed at the docking site with the external fixator removed. The mean defect size was 5.9 cm (3.8 to 9.3) and mean external
fixation index was
13.4 days/cm (11.8 to 19.5). In all cases, primary union of the
docking site and distraction callus was achieved, with an excellent
bony result. There was no recurrence of deep infection or osteomyelitis,
and with the exception of one patient with a pre-existing peroneal
nerve injury, all achieved an excellent or good functional result. With short external fixation times and low complication rates,
bone transport with a locking plate could be recommended for patients
with segmental tibial defects. Cite this article:
We reviewed 116 patients who underwent 118 arthroscopic ankle arthrodeses. The mean age at operation was 57 years, 2 months (20 to 86 years). The indication for operation was post-traumatic osteoarthritis in 67, primary osteoarthritis in 36, inflammatory arthropathy in 13 and avascular necrosis in two. The mean follow-up was 65 months (18 to 144). Nine patients (10 ankles) died before final review and three were lost to follow-up, leaving 104 patients (105 ankles) who were assessed by a standard telephone interview. The pre-operative talocrural deformity was between 22° valgus and 28° varus, 94 cases were within 10° varus/valgus. The mean time to union was 12 weeks (6 to 20). Nonunion occurred in nine cases (7.6%). Other complications included 22 cases requiring removal of a screw for prominence, three superficial infections, two deep vein thromboses/pulmonary emboli, one revision of fixation, one
The results and complications of 104 vascularised fibular grafts in 102 patients are presented. Bony union was ultimately achieved in 97 patients, with primary union in 84 (84%). The mean time to union was 15.5 weeks (8 to 40). In 13 patients, primary union was achieved at one end of the fibula and secondary union at the other end. In these patients, the mean time to union was 31.1 weeks (24 to 40). Five patients failed to achieve union, with a resultant pseudarthrosis (3 patients) or amputation (2 patients). There were various complications. Immediate thrombosis occurred in 14 cases. In two of 23 patients with osteomyelitis, infection recurred at two and six months after surgery, respectively. Both patients had active osteomyelitis less than one month before the operation. Bony infection occurred in a patient with a synovial sarcoma of the forearm one year after surgery. In 15 patients, 19 fractures of the fibular graft occurred after bony union, all except one within one year after union. In patients in whom an external fixator had been used, fracture occurred soon after its removal. Union was difficult to achieve in cases of congenital pseudarthrosis of the tibia. Appropriate alignment of the fibular graft is an important factor in preventing
