Management of Intercalary Tibial Bone Defect by Ilizarov Technique

Abstract

Segmental tibial bone loss can result from trauma, infection, or malignancy. Few bone defects cannot be reconstructed due to existence of several reliable reconstruction methods however; reconstruction remains an elective procedure that demands a significant investment of time, resources and efforts by the patient and surgeon. (1)

Optimal patient characteristics for segmental bone defect reconstruction include a reliable and well-informed patient with stable soft-tissue envelope, adequate nutritional status and the absence of tobacco use. Many patients present with less than ideal characteristics, increasing the difficulty of successful reconstruction. In example, Segmental bone loss as a result of high-energy trauma which devastates the patient physically, psychosocially, and economically. Compassion and empathy are as necessary as technical skill in achieving the best possible outcome. The Lower Extremity Assessment Project (LEAP) demonstrated that outcome of limb threatening trauma is influenced by the patient’s socioeconomic factors more than by technical successes of surgery. (2)

Some surgeons have classified management protocols based on the length of the segmental bone defects: a) 0.5-3cm Cancellous bone grafting ; b)2-10cm segmental Bone transport ; c)5-12cm Free Vascularized bone grafting ; and d) 10-30cm Distraction osteogenesis or Amputation. (1)

Other surgeons consider factors other than length of the defect to be so important that they do not base the treatment primarily on the size of the segmental defect such as Classification and reconstruction options suggested by May and Jupiter which focused on the status of the tibia and ipsilateral fibula as a guide during the selection of the appropriate reconstruction procedure especially in cases of osteomyelitis induced bone defects. (3)