Amjad Iqbal, M Suhail Amin.
Intercalary Bone segment transport in treatment of segmental Tibial defects.
J Coll Physicians Surg Pak Jan ;12(2):110-7.

Objective: To evaluate the results and complications of intercalary bone segment transport in the treatment of segmental tibial defects. Design: This is a retrospective analysis of patients with segmental tibial defects who were treated with intercalary bone segment transport method. Place and Duration of Study: The study was carried out at Combined Military Hospital, Rawalpindi from September 1997 to April 2001. Subjects and Methods: Thirteen patients were included in the study, who had developed tibial defects either due to open fractures with bone loss or subsequent to bone debridement of infected nonunions. The mean bone defect was 6.4 cms and there were eight associated soft tissue defects. Locally made unilateral `Naseer-Awais` (NA@) fixator was used for bone segment transport. The distraction was done at the rate of 1 mm/day after 7-10 days of osteotomy. The patients were followedup fortnightly during distraction and monthly thereafter. The mean follow-up duration was 18 months. Results: The mean time in external fixation was 9.4 months. The `mean healing index` was 1.47 months/cm. Satisfactory union was achieved in all cases. Six cases (46.2%) required bone grafting at target site and in one of them grafting was required at the level of regeneration as well. All the wounds healed well with no residual infection. There was no residual leg length discrepancy of more than 20 mm and one angular deformity of more than 5 degrees. The commonest complication encountered was pin track infection seen in 38% of Shanz screws applied. Loosening occurred in 6.8% of Shanz screws, requiring re-adjustment. Ankle joint contracture with equinus deformity and peroneal nerve paresis occurred in one case each. The functional results were graded as `good` in seven, `fair` in four, and `poor` in two patients. Overall, thirteen patients had 31 (minor/major) complications with a ratio of 2.38 complications per patient. To treat the bone defects and associated complications, a mean of 3.3 operations per patient were required. Conclusion: Limb salvage is possible in segmental defects of tibia using intercalary bone segment transport treatment. Locally made unilateral `Naseer-Awais` fixator yields satisfactory results, comparable to other studies.

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