Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft

Hyub Sakong; Ki Cheor Bae; Chul Hyun Cho; Kyung Jae Lee; Eun Seok Son; Du Han Kim

doi:10.12671/jkfs.2012.25.4.288

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Sakong, Bae, Cho, Lee, Son, and Kim: Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(4): 288-294.

Published online: 19 October 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.4.288

Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft

Hyub Sakong, M.D., Ki Cheor Bae, M.D., Chul Hyun Cho, M.D., Kyung Jae Lee, M.D., Eun Seok Son, M.D., Du Han Kim, M.D.

Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

Address reprint requests to: Ki Cheor Bae, M.D. Department of Orthopedic Surgery, Keimyung University School of Medicine, 56, Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel: 82-53-250-7729, Fax: 82-53-250-7205, bkc@dsmc.or.kr

Received 18 April 2012 Revised 22 May 2012 Accepted 10 July 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to evaluate the results of intramedullary nail fixation with autogenous iliac bone graft for defects of bone after tibial fractures.

Materials and Methods

Ten patients with bone defects in tibial fractures who had been treated with intramedullary nail fixation with autogenous iliac bone graft between May 2005 and September 2008 with more than 12 month follow-up were subject to study. Of the 10 patients, 8 were male and 2 were female, and the mean age was 50.2 years (29~76 years). By cause of accident, motor vehicle accidents caused 9 cases, a crush caused 1 case, and the average follow-up period was 21.9 months (12~42 months). Radiologically, we analyzed the union of the bone defect on simple x-ray and clinical evaluation was performed using the estimate method of Mekhali.

Results

This study reveals that there was radiological union in all 10 cases and the mean time to union was 8.4 months (5~18 months). By clinical evaluation according to Mekhali's estimate method, 9 patients had excellent outcomes and 1 patient had limitation of motion in the ankle joint rated as a fair clinical result. None of patients developed complications post-operatively.

Conclusion

Our study demonstrated that the intramedullary nail fixation with autogenous iliac bone graft can be a useful operative method because it can remove external fixators early and reduce complications, and autogenous bones have exceptional osteoconduction, osteoinduction, and bone-forming ability resulting in excellent union of bones.

Keywords: Tibial fractures, Bone defect, Intramedullary nailing, Autogenous bone graft

Figures and Tables

Fig. 1

A 31-year-old male with Gustilo-Anderson type II open fracture on his right tibia.

(A) Radiograph shows comminuted fracture at distal 1/3 of right tibiofibular shaft.

(B) Immediate postoperative radiography shows defect of boneon the distal tibial shaft.

(C) Two months later, the external fixator was removed and intramedullary nail fixation was done.

(D) A bone defect was detected, so a bone graft was done on the bone defect site.

(E) Five months after the bone graft, a radiograph shows that bony union was achieved.

Fig. 2

A 56-year-old female with Gustilo-Anderson type IIIB open fracture on his left tibia.

(A) Radiograph shows comminuted fractures at distal 1/3 of left tibia shaft and lateral malleolus.

(B) Immediate postoperative radiography shows defect of bone on the distal tibial shaft.

(C) Multiple drilling was done for bleeding at the fracture site.

(D) Four months later, the external fixator was removed and intramedullary nail fixation was performed.

(E) A bone defect was detected, so a bone graft was performed on the bone defect site.

(F) Seven months after the bone graft, a radiograph shows that bony union was achieved.

Table 1

Summary of Cases

G-A classification: Gustilo and Anderson classification, EF: External fixator, M: Male, F: Female.

Table 2

Clinical Outcome Evaluation Criteria

ADLs: Activities of daily living.

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