According to a presentation at the Limb Lengthening and Reconstruction Society Annual Meeting, balanced cable transport with circular fixation with intramedullary nailing may be a reliable and safe treatment for tibial bone loss correlated with severe open fractures, infected nonunions and osteomyelitis.
“It is exciting to share our experience in bone loss reconstruction using the balanced cable transport and then nailing (BCTATN) method,” Stephen Quinnan, MD, told Healio.com/Orthopedics. “This method offers incredible flexibility in taking care of a large range of complex problems with associated bone loss. The method also is effective at addressing leg length inequality, facilitating of weight-bearing and optimizing alignment, but most importantly, the external fixator index is extremely short and the bone healing index, especially for the multifocal transports, are the fastest ever reported.”
Quinnan and colleagues performed a retrospective review to identify 54 patients who underwent balanced cable transport. Of these patients, 37 patients underwent cable bone transport and then immediate intramedullary nailing for segmental tibia bone loss. Of this cohort, 29 patients completed follow-up to healing. On average, the follow-up was 16 months.
Results showed 24 patients had defects from severe open tibia fractures, four patients had defects from tibial septic nonunion and one patient had a defect from osteomyelitis. On average, the bone loss was 11.6 cm. There were 20 patients who had a single-level osteotomy and nine patients had multifocal transport. The external fixation time, on average, was 131 days. Healing time, on average, was 273 days. The healing index, on average, was 1.1 months per centimeter of bone loss.
Investigators noted the fracture union rate and regeneration bone healing was 100%. Six months after healing, one patient developed a deep infection and need debridement, nail removal and intravenous antibiotics. At the final follow-up, the patient had no further sequelae or limitations.
At healing, the average medial proximal angle was 86.7°. The medial distal tibia angle was 89.8°, the proximal posterior tibia angle was 79.2 and the anterior distal tibia angle was 80.4°. There was no incidence of malalignment greater than 5°.
“We believe that this reconstruction paradigm represents a huge step forward in improving the results of reconstruction, as well as greatly accelerating the time required for reconstruction,” Quinnan said. “We believe this method represents a new gold standard for bone loss reconstruction in the tibia." – by Monica Jaramillo
Quinnan S, et al. Balanced cable transport with circular external fixation and then nailing for segmental tibia bone defects. Presented at: Limb Lengthening and Reconstruction Society Annual Meeting; July 19-20, 2019; Boston.
Disclosure: Quinnan reports no relevant financial disclosures.