Enhanced Bone Healing in Tibial Osteogenesis Using the Distraction Holiday Protocol in Ilizarov Fixation

This study aimed to evaluate the outcomes and complications of a new distraction holiday technique, to optimize and shorten regenerate healing in patients treated with Ilizarov fixation for critical tibial bone defects.

This prospective observational study included patients who underwent Ilizarov fixation for critically sized tibial defects (> 6 cm) due to varying etiologies at a tertiary care center between 2018 and 2023 with a minimum 2-year follow-up. All patients underwent a single corticotomy and followed the same distraction protocol with 10 days of distraction (1 mm/day) followed by 4 days of holiday phase in a repeating sequence until the desired length was achieved. Functional outcomes, healing indices and complications were assessed.

Nine patients with a mean age of 29.67 (SD = 14.21) years and mean post-op length of distraction of 8.05 cm were evaluated. Patients had a mean distraction duration and total external fixation time of 112.22 (SD = 38.28) and 297.56 (SD = 68.25) days, respectively. The modified bone healing index (37.82 days) and regenerate consolidation index (32.99 days) was significantly less than expected by 31.03% (SD = 11.5). Majority of the patients (N = 6, 66.7%) had excellent ASAMI bone and function score. 6 (66.7%) patients reported pin-tract infections. None of the patients had residual infection and there was no incidence of any refractures.

The study demonstrated reduced bone healing index and regenerate consolidation index with this distraction holiday technique in managing tibial bone defects alongside high-quality regenerate formation and satisfactory functional outcomes. The study, however, acknowledges the limitations of a small sample size and heterogeneity of the patient population, suggesting the need for further trials to validate these findings.