Massive Tibial Defect Treated with Plate-assisted Bone Segment Transport and A Novel Internal Cable-Pulley System

The treatment of massive diaphyseal tibial bone defects remains challenging with poor results seen from treatment modalities other than bone transport (BT). Current methods of BT require lengthy periods in a circular external fixator. Despite recent modifications in BT techniques via circular external fixator such as multifocal transport and immediate intramedullary nailing after docking, circular external fixation remains poorly tolerated with a high complication profile. Newer technologies such as magnetic lengthening nails have shown promise to provide alternatives to BT without resorting to long-term circular external fixation. Plate-assisted bone segment transport (PABST) has demonstrated success as an all-internal BT technique. Prior case reports have shown a modest ability to treat massive defects with varying success.

A novel all-internal cable and pulley augmentation to a PABST technique for a massive (185 mm) tibial defect was utilised during a retrograde transport. The authors describe a patient scenario in which this augment allowed continued transport that could not be treated with an additional Precice nail recharge.

Augmentation of PABST with a cable and pulley construct can successfully treat massive diaphyseal defects.

This cable and pulley modification to PABST allows for the treatment of massive tibial defects without the need for magnetic lengthening nail exchange or conversion to external fixation.

Lance D, Morpeth B, Faith H, et al. Massive Tibial Defect Treated with Plate-assisted Bone Segment Transport and A Novel Internal Cable-Pulley System. Strategies Trauma Limb Reconstr 2024;19(2):118-124.