Plate-assisted segmental bone transport with a lengthening nail and a plate. A new technique for treatment of tibial and femoral bone defects

BackgroundDistraction osteogenesis represents an effective procedure for treatment of bone defects from various causes (e.g. trauma, malignancy, congenital and infection). In the past the available procedures were practically exclusively external.PrinciplesIn the plate-assisted segmental bone transport (PABST) procedure a commercially available motorized intramedullary lengthening nail is used for segment transport. The transport segment is transported along a bone plate, which is responsible for maintaining the position of the proximal and distal main fragments.Surgical techniqueIn staged sequences, aplate spanning the defect is placed. A lengthening nail is inserted in an antegrade or retrograde direction and avascularized transport segment is created with an osteotomy. Bone transport is initiated at 1.0 mm a day. The transport segment is pulled or pushed into place, depending on the location of the bone void. In due time, a docking procedure is performed and full weight bearing is allowed. Supplementary lengthening can be initiated at docking or in a separate procedure.In smaller defects the gap is closed immediately over the plate and the bone is lengthened by the nail in the opposite end of the defect.ConclusionThe presented method is avaluable addition to the armamentarium for treatment of bone defects. The main advantages are the avoidance of external fixation (fixation wires, Schanz screws) and the creation of physiological bone substitute. Vital soft tissues are essential for agood outcome. With appropriate management (systematic debridement, local and systemic administration of antibiotics and free soft tissue flaps), this method can be asolution to even complex reconstructive problems.