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Plate-assisted Bone Segment Transport With Motorized Lengthening Nails and Locking Plates: A Technique to Treat
Ulrik Kähler Olesen1, Tobias Nygaard1, Daniel E Prince1
1Rigshospitalet, Department of Orthopedic Surgery, Copenhagen Limb Lengthening and Bone Reconstruction Unit, Denmark (Dr. Kähler Olesen, Dr. Nygaard, and Dr. Singh); the Memorial Sloan Kettering Cancer Center, Orthopedic Service, New York City, NY (Dr. Prince); the Sinai Hospital, Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening, Baltimore, MD (Dr. Herzenberg); the Springfield Clinic, Springfield, IL (Dr. Gardner); the Nuffield Orthopedic Centre, Oxford University Hospitals, UK (Dr. McNally); and the Children's University Hospital, Dublin, Ireland (Dr. Green).
Abstract:
This article describes a new bone transport technique for femoral and tibial bone defects using lengthening nails combined with locking plates. We term it plate-assisted bone segment transport (PABST).
Methods:
Nine patients with five femoral and four tibial bone defects from open fractures or malignancies were treated between 2016 and 2018. Mean femoral defect length was 9.3 cm (range 7 to 11.5). Mean tibial defect was 8.9 cm (range 4.8 to 15). The patients were evaluated for time to weight bearing, consolidation index, mechanical axis deviation, and limb length discrepancy.
Results:
Seven of nine patients have fully consolidated. The mean consolidation time was 6.6 months. The consolidation index was 0.9 (femur) and 1.26 (tibia) mo/cm. Two patients required supplementary lengthening. One patient had mild varus, one mild valgus; the remainder had a normal mechanical axis. Limb length discrepancy remained acceptable in all patients. The main complications were heterotopic ossification, delayed healing, and reduced knee motion.
Conclusion:
Bone transport with lengthening nails and locking plates is an effective and patient-friendly way of treating bone defects, eliminating the adverse effects of external fixation and reducing treatment time. The plate provides stability during transport and docking; it can address concomitant fractures and facilitates acute shortenings.
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