Tibial Defect Case for small group discussion Bone

Tibial Defect Case for small group discussion: Bone defects AOTrauma External Fixation

What is your treatment? • 18 -year-old-man • 2 years ago resection of the proximal part of left tibia (sarcoma) and total knee replacement • Deep infection 1 year later • Surgical debridement and removal of prosthesis • 15 cm defect, shortening 12 cm • Remission of infection during 6 months Defect 33 -D 1 + 41 -D 3

Next step? • Two-level corticotomy Docking site? Fragments stabilization? • Devise: ring with cable technic traction • Method: segment transportation at tibia femur

Step 2 • Open docking site • Remove fibrous tissue, bone freshening • Soft-tissue coverage

Fixation period 9 months

• 1 month after external fixator removal • Residual shortening at the end of this stage was 12 cm

Next step? • Left femur lengthening? • Lengthening of the tibia? • Shortening of the opposite side?

Step 3 Lengthening of femur and tibia

Treatment period of 3 -d step: 15 months 4 -year follow-up

Take-home messages • Long-bone defect and severe shortening, multifocal corticotomy/transport can reduce external fixation time • Ring fixator is appropriate in complex and unstable fragment • Complex problems may need staged operation • Cable technique is one option in segmental bone transportation 12