The Journal of Bone and Joint Surgery (American). 2007;89:2218-2224.
doi:10.2106/JBJS.F.01579
© 2007 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 Foot/Ankle Test 10: Winter 2008 (publication date February 15, 2008; expira...
Trauma Test 20: Winter 2008 (publication date February 15, 2008; expiration...
Oncology Test 5: Winter 2008 (publication date February 15, 2008; expiratio...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Eralp, L.
Right arrow Articles by Bulbul, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Eralp, L.
Right arrow Articles by Bulbul, M.
Related Collections
Right arrow Adult Trauma
Right arrow Foot/Ankle
Right arrow Oncology
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail

The Combined Technique

Levent Eralp, MD1, Mehmet Kocaoglu, MD1, Nazri Mohd Yusof, MMed(Ortho)2 and Murat Bulbul, MD3

1 Department of Orthopaedics and Traumatology, Istanbul Medical School, Istanbul University, Capa 34390, Istanbul, Turkey. E-mail address for L. Eralp: yeralp{at}superonline.com
2 Kulliyyah of Medicine, International Islamic University of Malaysia, Jalan Hospital, 25150 Kuantan, Pahang, Malaysia
3 Vakif Gureba Training Hospital, 34380 Topkapi, Istanbul, Turkey

Investigation performed at the Department of Orthopaedic Surgery and Traumatology, Istanbul Medical School, Istanbul University, Istanbul, Turkey

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been introduced to overcome these problems. The present study investigates this combined technique.

Methods: Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular external fixator and an intramedullary nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months.

Results: The mean size of the bone defects in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean external fixation time was 3.5 months, and the mean external fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment).

Conclusions: The combined technique is an improvement over the classic external fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of external fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?