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In the present study, we presented our experience with a new modified technique of shortening and re-lengthening using a monolateral external frame combined with a calcaneal intramedullary nail and compared it with the bone transport technique for the treatment of distal tibial periarticular post-traumatic defects. Forty-one patients were retrospectively analyzed. Among them 19 were treated using our modified shortening and re-lengthening technique (MSR group) and 22 by bone transport (BT group). The difference in external fixation time (EFT), external fixation index (EFI), self-rating anxiety scale (SAS), and complications were compared between the two groups. The mean EFT was 3.4 ± 0.6 months in the MSR group and 7.5 ± 1.4 months in the BT group; the EFI was 0.57 ± 0.06 month/cm and 1.32 ± 0.23 month/cm, respectively. The EFT, EFI, and SAS scores were significantly lower in the MSR group than in the BT Group (p < 0.05). The mean number of complications per patient in the BT group was nearly 2.4 times that of the MSR group (p < 0.05). Our modified shortening and re-lengthening technique reduced the EFI and complication incidence compared to the bone transport technique. Therefore, patients with distal tibial periarticular post-traumatic defects can achieve great satisfaction with this new technique. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper was to compare the clinical effects of acute shortening and re-lengthening (ASR) technique with antibiotic calcium sulfate-loaded bone transport (ACSBT) technique for the management of large segmental tibial defects after trauma. Methods: In this retrospective study, 68 patients with large segmental tibial defects were included and completely followed. The bone loss was 3–10 cm. ASR group included 32 patients, while ACSBT group contained 36. There was no significant difference in demographic information between the two groups. The external fixation time (EFT) and external fixation index (EFI) were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification. Results: The mean EFT was 9.2 ± 1.8 months in ASR group and 10.1 ± 2.0 months in ACSBT group, respectively. The mean EFI was 1.5 ± 0.2 month/cm and 1.4 ± 0.3 month/cm. According to the ASAMI criteria, in ASR group bone defect healing was excellent in 22 cases, good in 7 cases and fair in 3 cases. In ACSBT group, it was excellent in 23 cases, good in 11 cases and fair in 2 cases. In ASR group, the limb function was excellent in 15 cases, good in 7 cases and fair in 10 cases, while it was excellent in 14 cases, good in 9 cases and fair in 13 cases with ACSBT group. There was no significant difference in EFI, bone defect healing and limb functions between the two groups (p > 0.05). The mean number of complications per patient in ACSBT group was significantly lower than that in ASR group (p < 0.05). Conclusion: Both techniques can be successfully used for the management of large segmental tibial defects after trauma. There was no significant difference in EFI, limb functions and bone defect healing between the two groups. Compared with ASR group, the complication incidence in ACSBT group was lower, especially the infection-related complications. Therefore, for patients with large segmental bone defects caused by infection or osteomyelitis, ACSBT technique could be the first choice. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the clinical effects of antibiotic calcium sulfate-loaded hybrid transport (ACSLHT) and traditional Ilizarov bone transport (TIBT) in the treatment of large tibial defects after trauma. Methods: Eighty-five patients with large tibial defects after trauma were selected for retrospective study. The range of tibial defects was 6–22 cm. After thorough debridement and infection controlled, bone transport technique was used to reconstruct tibial defects. Forty-four patients were treated with ACSLHT technique (the ACSLHT group), while the other 41 were treated with TIBT technique (the TIBT group). Time in external fixator was evaluated by EFI score. Enneking score was used to evaluate limb functions. SAS score was used to evaluate postoperative anxiety status. In addition, complication incidence was compared, including axis deviation, docking site nonunion, infection recurrence and so on. Results: There was no significant difference in preoperative general data between ACSLHT and TIBT group. EFI score in ACSLHT and TIBT group was 0.6 ± 0.1 cm/month and 1.7 ± 0.3 cm/month, respectively (P < 0.05). Enneking score of ACSLHT and TIBT group was 86.5% and 75.1% (P < 0.05). SAS score of ACSLHT group was significantly lower than that of TIBT group (P < 0.05). Complication incidence in ACSLHT group was significantly lower than that in TIBT group (P < 0.05). Conclusions: Compared with TIBT group, ACSLHT group had shorter time in external fixator, better limb functions, lower postoperative anxiety score and lower complication incidence which is worth of clinical promotion. [ABSTRACT FROM AUTHOR]