87.
Bone transport of the tibia with a motorized intramedullary nail
(
Fitbone).
Søren Kold, Knud Stenild Christensen
Orthopaedics Aalborg Sygehus; Orthopaedics, Aalborg Sygehus
Background:
So far bone transport in the tibia has only been performed in
combination with external fixation.
Purpose / Aim of Study:
To our knowledge we report the first case in the
world of bone transport in the tibia only by use of an intramedullary nail.
Materials and Methods:
53
years old male treated with locking plates for an
AO-type 42-B1 closed fracture of the distal tibia and fibula. Developed an
atrophic non-union. Was reoperated with bone graft and exchange of the
locking plates. Developed again an atrophic non-union with a varus deformity
of 18 degrees and 2 cm shortening of the tibia. Broken locking plate and
screws were removed. The atrophic non-union (3.1 cm bone segment) was
resected until vital bone.The proximal tibia and the fibula were osteotomized.
A custom-made tibial nail with the ability to do initial bone transport and
subsequent bone lengthening was inserted. 4 weeks postoperative BMP-7 was
administered to the docking site.
Findings / Results:
Partial weight-bearing was allowed after 2 months when
the proximal tibia had been lengthened 5.1 cm (3.1 cm bone transport plus 2
cm leg lengthening). Full weight- bearing was allowed after 29 days/cm bone
lengthening. The docking-site was united 4 months postoperative. Healing
time for the regenerate was 45 days/cm bone lengthening. There was no leg
length discrepancy and the tibia had a 3 degrees varus deformity. Range of
motion of knee and ankle on the operated side was equal to the healthy side.
Complications: A locking screw was exchanged and a tibiofibular transfixing
screw was removed. Posterior proximal tibial angle went from preoperative 80
degrees to postoperative 71 degrees.
Conclusions:
It is possible to obtain a good result when only an
intramedullary lengthening nail is used for tibial bone transport. A blocking
screw is recommended to prevent procurvatum of the proximal tibia.
