Ipsilateral medial fibular transport using a circular external fixator for reconstruction of massive tibial bone defects in children and adolescents

Background
Ipsilateral fibular transport is a novel option in limb salvage surgery for patients with large tibial defects. A less common application of the Ilizarov technique is transverse bone transport. The frame allows for gradual transport of the fibula into the adjacent tibial defect site, with precise proximal and distal alignment of the fibula, and compression at tibial contact sites. Here, we outline a method of limb salvage for large tibial bone loss using ipsilateral medial fibular transport using the Ilizarov apparatus in a group of children and adolescents.
Patients and methods
We retrospectively reviewed six consecutive patients, average age 8 years (range 3–18 years), with infection or trauma-related large tibial bone loss. All patients were treated using gradual medial transport of the ipsilateral fibula using the Ilizarov technique. The follow-up of the patients averaged 4 years, with a range of 4–7 years after removal of the circular external fixator. We reviewed patients' medical records and radiographs. We recorded the fracture type in trauma cases, length of the tibial segment replaced, time to union, additional procedures, knee and ankle range of motion, limb length, satisfaction with the reconstructive surgery compared with amputation, and possible complications.
Result
The Ilizarov ring fixation time to achieve fibular transport and bone union averaged 11 months (range from 7–17 months). The amount of tibial bone loss replaced using the Ilizarov frame with fibular transport averaged 9.8 cm, with a range of 8–11 cm. Hypertrophy of the transported fibula accompanied full weight bearing and satisfactory lower extremity joints motion occurred in all patients. Four of the six patients had a superficial pin-site infection. All patients and or parents were satisfied with the results, and none of them reported that amputation would have been a better option.
Conclusion
The Ilizarov technique of ipsilateral medial fibular transport to address massive tibial bone loss led to limb salvage for our six patients, with satisfactory functional results. Adolescent patients may require iliac crest bone grafting at the docking sites if the healing response is poor. Our work shows that ipsilateral fibular gradual transport in children and adolescents provides a reasonable alternative for surgeons addressing limb salvage in patients with large tibial bone loss. Patients should be treated by surgeons familiar and experienced with the Ilizarov method.