SEGMENTAL DISPLACEMENT WITH BONE DISTRACT ION IN WIDE OPEN TIBIAL FRACTURES

In open tibial fractures with defects over 4 cm, spongiosaplasty is co nsidered to be insufficient. Since 1988 we have tried to apply Ilisaro v's ideas of callus distraction in combination with modern external fi xation devices and AO/ASIF implants. By August 1995, 15 patients with severe tibial fractures had been treated. The bone defect averaged 7 c m. Thus, more than 1 m of tubular bone was produced. Eleven male and 4 female patients, averaging 21.3 years in age, were given this treatme nt. The defect was caused by resection of a malignancy in 3 cases and a second- or third-degree open fracture in 12 cases, accompanied by os teomyelitis in 6 cases. Reconstruction required an average of 5.3 oper ations. The complication rate was 53%, and the median duration of trea tment was about 1 year. The final results were excellent or good. Ampu tation could be avoided in all instances. This treatment is contra ind icated if the patient exhibits a lack of compliance. There is a realis tic chance of salvaging the limb in cases of severe soft tissue and bo ne defects. In terms of economical considerations, this treatment is c ost effective. Physical integrity and mobility without aid is the impo rtant motivation for these patients.