Treatment Methods for Tibial Fracture Defects

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- See: Tibial Non Unions:

- Discussion:
    - tibial bone grafting: (bone graft harvest technique)
         - w/ defects less than 6 cm iliac crest bone grafting may be sufficient;
                - tibial-fibular synostosis using cancellous bone may be indicated in some cases;
         - papineau technique:
         - posterolateral bone grafting:
    - free fibular transfer;
         - w/ defects greater than 6 cm, free fibular transfer from contralateral leg is indicated;
                - see free fibular harvest;
    - bone transport methods:
         - tibial transport:
                - distraction histiogenesis
                - limb lengthening fixators
                - tibial lengthening
                - references:
                       - Segmental tibial defects. Comparing conventional and Ilizarov methodologies.
                       - Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects.
                       - Treatment of traumatic bone defects by bone transport.
                       - Distraction osteogenesis after acute limb-shortening for segmental tibial defects. Comparison of a monofocal and a bifocal technique in rabbits.
                       - Ilizarov bone transport treatment for tibial defects.
                       - Functional Outcome Following Bone Transport Reconstruction of Distal Tibial Defects. 
                       - Complications Encountered During Lengthening Over an Intramedullary Nail 
                       - Bifocal compression-distraction in acute treatment of grade III open tibia frx with bone and soft-tissue loss: a report of 24 cases.
                       - Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail. The Combined Technique  

         - fibular transport:
                 - in the report by RM Atkins et al 1999, the authors discuss a method of tibialisation of the fibula (for massive tibial bone loss) using the Ilizarov fixator system;
                       - all had successful transport, proximal and distal union, and hypertrophy of the graft without fracture;
                       - one developed a squamous-cell carcinoma which ultimately required amputation of the limb;
                       - advantage of IVFT is that the fibular segment retains its vascularity without the need for microvascular dissection or anastomoses;
                 - references:
                       - Ipsilateral fibular transposition in tibial nonunion using Huntington procedure: a 12-year follow-up study.
                       - Ipsilateral vascularised fibular transport for massive defects of the tibia.
                               R. M. Atkins, P. Madhavan, J. Sudhakar, D. Whitwell  J Bone Joint Surg [Br] 1999;81-B:1035-40.
                       - Ipsilateral pedicle vascularized fibula grafts for reconstruction of tibial defects and non-unions.

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Acute and definitive management of traumatic osteocutaneous defects of the lower extremity.

The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury.

Management strategies for bone loss in tibial shaft fractures.

Management of open fractures with sterilization of large, contaminated, extruded cortical fragments.

Closure of the skin defect overlying infected non-union by skin traction.

To Reconstruct or Not to Reconstruct?

Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail


Adult posttraumatic osteomyelitis of the tibia.
Intramedullary infections treated with antibiotic cement rods: preliminary results in nine cases.

Posterolateral bone graft of the tibia.


Autologous marrow injection as a substitute for operative grafting of tibial nonunions.
Early prophylactic bone grafting of high-energy tibial fractures.