Balanced Cable Bone Transport to an Ankle Fusion With Automated Struts: Techniques and Case Review

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Limb Reconstruction

Background:

• Complex distal tibial injuries with segmental bone loss, joint destruction, and osteomyelitis pose significant limb salvage challenges.
• Current treatments often involve prolonged external fixation and may lead to suboptimal outcomes.

Purpose of the Study:

• To describe a novel technique for managing complex distal tibial injuries.
• To evaluate the efficacy of circular external fixation with trifocal balanced cable transport and primary ankle arthrodesis.

Main Methods:

• A novel technique combining circular external fixation with trifocal balanced cable transport and primary ankle arthrodesis was employed.
• Automated balanced cable trifocal transport with speed multiplier pulleys was utilized for ankle arthrodesis.
• Staged conversion to internal fixation was performed as an adjunctive measure.

Main Results:

• The technique facilitated early weightbearing, soft tissue preservation, and alignment correction.
• External fixation time was minimized.
• Adjunctive internal fixation successfully mitigated risks of docking site nonunion and pin tract infections.

Conclusions:

• This innovative approach provides a viable option for limb salvage in complex distal tibial and osteochondral defects.
• The technique effectively reduces external fixation time, improving patient management.
• This is the first report detailing automated balanced cable trifocal transport for ankle arthrodesis.