The Journal of Bone and Joint Surgery, Vol 71, Issue 7 994-1004, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Reconstruction of large diaphyseal defects, without free fibular transfer, in Grade-IIIB tibial fractures
EP Christian, MJ Bosse and G Robb
Department of Orthopedic Surgery, Naval Hospital, Portsmouth, Virginia 23708.
Eight Grade-IIIB tibial fractures that were associated with large
soft-tissue and segmental diaphyseal defects, averaging ten centimeters in
length, were successfully reconstructed without the use of a free fibular
transfer. A free tissue flap was the preferred form of soft-tissue
coverage. The osseous reconstruction was accomplished by using a massive
amount of autogenous cancellous bone graft. Beads that were made from
polymethylmethacrylate and impregnated with two antibiotics at the time of
operation were used as soft-tissue spacers to preserve the volume of the
diaphyseal defect for later receipt of the cancellous bone graft. The beads
prevented the soft-tissue flap from collapsing into and adhering to the
site of the tibial defect. The beads also served as vehicles for local
delivery of the antibiotics that they contained. When the soft-tissue flap
had healed, the beads were replaced with cancellous graft. All of the
tibiae healed. The time to healing averaged nine months. The average
duration of external fixation was 5.5 months. One deep infection developed,
but resolved after debridement and antibiotic therapy. This conservative
technique is safe and reliable for patients who have sustained a
high-energy tibial fracture and a large segmental diaphyseal defect.
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