Ilizarov trifocal lengthening followed by intramedullary nailing for massive posttraumatic tibial bone defects

The treatment of massive tibial bone defects takes a very long time. An Ilizarov trifocal approach decreases the lengthening time. Subsequent intramedullary fixation decreases the complications of the conventional Ilizarov method. This technique was applied between June 2010 and June 2011 in 10 male patients with a mean age of 30 years. All had grade III open tibial fractures. The patients were treated at Mansoura University Hospital and a private hospital. The sequence of treatment included trifocal lengthening using the Ilizarov method, followed by removal of the fixator, temporary plaster cast immobilisation and subsequent intramedullary fixation until complete union was achieved. The length of the tibial bone defect ranged between 6-12 cm; the lengthening time ranged between 45-75 days and the consolidation time ranged between 90-160 days. The results were evaluated according to Paley's bone and functional assessment scores. The bone results were excellent in 7 patients and good in 3. Two patients had non union and one patient had pin tract infection. The functional results were excellent in 7 patients and good in 3. Two patients had equinus deformity and one patient had limited range of knee motion. There were no deep infections, DVTs or leg length discrepancies greater than 2.5 cm. Ilizarov trifocal lengthening followed by delayed intramedullary fixation appeared in this study as a good method of treatment for massive posttraumatic tibial bone defects. It reduced fixator time and minimized the complications associated with the Ilizarov fixation.