Bone Defects in Tibia Managed by the Bifocal vs. Trifocal Bone Transport Technique: A Retrospective Comparative Study

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Regenerative Medicine

Background:

• Infected long segmental tibial bone defects pose significant reconstructive challenges.
• Monolateral rail external fixators are utilized for limb reconstruction.
• Comparing bone transport techniques is crucial for optimizing outcomes.

Purpose of the Study:

• To evaluate the clinical effectiveness of trifocal bone transport (TFT) versus bifocal bone transport (BFT).
• To identify differences in outcomes for tibial bone defect reconstruction using a monolateral rail external fixator.

Main Methods:

• Retrospective analysis of 53 patients with infected long segmental tibial bone defects treated between January 2013 and April 2019.
• Patients were divided into two groups: 32 treated with BFT and 21 with TFT.
• Data collected included demographic information, operation duration, docking time, external fixation time, external fixation index, and complications (Paley classification). Clinical outcomes were assessed using Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria.

Main Results:

• Both TFT and BFT achieved infection-free union with no significant differences in ASAMI bone and functional scores.
• TFT involved larger defect sizes and longer operation durations compared to BFT.
• TFT demonstrated significantly shorter docking time, external fixation time, and external fixation index.
• Complications and difficulties were significantly more prevalent in the BFT group.

Conclusions:

• Both TFT and BFT techniques provide satisfactory outcomes for reconstructing infected long segmental tibial bone defects with monolateral external fixators.
• The TFT technique offers significant advantages by reducing docking time, external fixation time, external fixation index, and the incidence of complications compared to the BFT technique.