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

Objectives: To compare two different methods of segment transport in posttr aumatic and postseptic tibial defects by employing intramedullary tibial na ils 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 t ibial shaft were admitted at our center between January 1994 and December 1 995. For study purposes, they were divided into two groups with fifteen pat ients in each. Methods: All thirty patients underwent a standardized therapy protocol cons isting of three phases: (a) eradication of infection, (b) restoration of so ft tissue defects, and (c) bone segment transport. The first two phases wer e identical for both groups. The third phase was different: in Group A tran sport of the segment was performed with a combination of intramedullary nai l 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 kne e and ankle joint, transport time, reoperations, complications) to determin e treatment success. Results: Both methods are useful for segment transport in patients with tib ial shaft defects following trauma and infection. The relative transport ti me 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 rat e than did Group A (septic complications, twenty-six versus six events; nec essary recorticotomies, four versus zero events). Conclusions: An intramedullary nail and wire towrope proves to be a reliabl e combination for segment transport in tibial defects following trauma and infection and provides a relatively high patient comfort rate and a low com plication rate.