Tibia Defect Transportation Nail_Oct52018.pptx

Tibial Defect
Case for small group discussion: Bone defects
How shall we treat the bone defect?

IM nail and Masquelet
Bone transport using a unilateral frame
Bone transport using Ilizarov frame
Bone transport over IM nail
Bone transport along a plate

1. Tibial Defect Case for small group discussion: Bone defects AO Trauma External Fixation

2. 46-year-old man Open fracture of mid shaft of tibia and distal fibula What is your treatment after debridement at this early stage?

3. Temporary unilateral external fixation Delayed primary wound closure How shall we treat the bone defect? IM nail and Masquelet Bone transport using a unilateral frame Bone transport using Ilizarov frame Bone transport over IM nail Bone transport along a plate

4. Temporary unilateral external fixation Delayed primary wound closure How shall we treat the bone defect? IM nail and Masquelet Bone transport using a unilateral frame Bone transport using Ilizarov frame Bone transport over IM nail Bone transport along a plate

5. What is the next step? How shall we treat the bone defect? IM nail and Masquelet Bone transport using a unilateral frame Bone transport using Ilizarov frame Bone transport over IM nail Bone transport along a plate

6. Resect the non-helpful portion: how do we decide? 12 cm bone defect

7. Blocking screw Corticotomy How was corticotomy performed? Options?

8. 1 wire and 1 pin in transport segment 2 locking screws (IM nail) in distal portion of tibia (A-P and M-L) 2 wires and 1 pin 2 wires and 1 pin

9. 6 weeks 12 weeks 17 weeks How fast do we transport? What problems to expect?

10. Docking at 18 weeks What shall we do at the docking site?

11. Bone graft at docking site What type of bone graft? From where? What sort of problems can we expect here?

12. 8 months after transport 16 months

13. 2.5 years 3 years

14. Take-home messages Bone transport over IM nail is a good option Advantages of this technique are: Shorten external fixation time Alignment control is predictable Good biomechanics

15. Take-home messages Potential problems In proximal fractures, a positioning screw or blocking screw technique is helpful Docking site still needs to be managed, autogenous bone grafting is common Infection along the nail?