Segment transport employing intramedullary devices in tibial bone defects following trauma and infection

Objectives: To compare two different methods of segment transport in posttraumatic and postseptic tibial defects by employing intramedullary tibial nails as the fixation system and to evaluate differences in the complication rate between external fixation and wire towropes as the transport system. Design: Randomized, prospective, nonblinded study. Setting: Level 1 trauma center. Patients: Thirty patients with posttraumatic or postseptic defects of the tibial shaft were admitted at our center between January 1994 and December 1995. For study purposes, they were divided into two groups with fifteen patients in each. Methods: All thirty patients underwent a standardized therapy protocol consisting of three phases: (a) eradication of infection, (b) restoration of soft tissue defects, and (c) bone segment transport. The first two phases were identical for both groups. The third phase was different: in Group A transport of the segment was performed with a combination of intramedullary nail and wire towrope; in Group B the intramedullary nail was combined with an external fixation device. We then evaluated both subjective data (patient comfort, restrictions in physiotherapy) and objective data (mobility of knee and ankle joint, transport time, reoperations, complications) to determine treatment success. Results: Both methods are useful for segment transport in patients with tibial shaft defects following trauma and infection. The relative transport time was shorter in Group A than in Group B (12.2 versus 13.7 days/centimeter; p = 0.002). Group B also recorded a significantly higher complication rate than did Group A (septic complications, twenty-six versus six events; necessary recorticotomies, four versus zero events). Conclusions: An intramedullary nail and wire towrope proves to be a reliable combination for segment transport in tibial defects following trauma and infection and provides a relatively high patient comfort rate and a low complication rate.