[Comparative efficacy of internal versus external BTLP technique with locking plates in treating large-segment...

To compare effectiveness of internal versus external bone transport with locking plate (BTLP) technique in treating large-segment infectious bone defects of tibia.

A retrospective analysis was conducted on 131 cases of large-segment infectious bone defects of tibia, who were admitted between July 2018 and October 2024 and met the selective criteria. All patients underwent primary debridement followed by antibiotic-containing bone cement filling, with secondary repair employing locking plates combined with external frame technology after infection control. Patients were allocated into an internal fixation group ( n=45) and an external fixation group ( n=86) based on the secondary fixation method: the internal fixation group utilized locking plates for maintaining alignment and stability, whereas the external fixation group combined locking plate fixation with external frames for reduction. No significant difference was observed between groups regarding age, gender, number of previous surgeries, proportion of patients with a history of smoking, type of bone infection, length of bone defect, and preoperative C-reactive protein level and erythrocyte sedimentation rate ( P>0.05). But there was a significant difference in preoperative white blood cell counting ( P<0.05). Clinical outcomes were recorded and compared between groups, including the re-debridement rates after the first-stage operation, the bone defect healing rates and healing time after the second-stage operation, the visual analogue scale (VAS) score for pain and external fixation index during bone transport, the infection recurrence rates during follow-up, Paley joint motion score, and occurrence of complications.

All patients completed treatment and were followed up 12-62 months (mean, 20.5 months). The re-debridement rate was significantly higher in the internal fixation group than in the external fixation group ( P<0.05). There was no significant difference in VAS scores, incidence of skin redness and swelling, or external fixation index between two groups during bone transport ( P>0.05). The internal fixation group had significantly shorter duration of pin tract exudation and lower joint restriction rate compared to the external fixation group ( P<0.05). Bone defects healed successfully in 122 cases (93.13%), with no significant difference in healing rates between groups ( P>0.05), but the internal fixation group required significantly longer healing time than the external fixation group ( P<0.05). During follow-up, the infection recurrence rate was significantly higher in the internal fixation group than in the external fixation group ( P<0.05). At last follow-up, the excellent and good rate of Paley joint motion score in the internal fixation group were significantly higher than those in the external fixation group ( P<0.05).

BTLP technique is effective for large-segment infectious bone defects, but for patients with poor skin and soft tissue conditions, the BTLP technique with external fixation can achieve better infection control. However, the treatment process needs to pay attention to the treatment of pin tracts and the adverse effects on joint mobility.