Tibial Bone Transport Over an Intramedullary Nail Using Cable and Pulleys

JBJS Essential Surgical Techniques
Mitchell BernsteinS Robert Rozbruch

Abstract

Massive bone defects (>8 cm) will not unite without an additional intervention. They require a predictable, durable, and efficient method to regrow bone. The Ilizarov method of tension stress, or distraction osteogenesis, first involves a low-energy osteotomy1-5. The bone segments are then pulled apart, most often using an external device at a specific rate and rhythm (distraction phase), after which the newly formed bone (the regenerate) requires time for consolidation. The consolidation phase is variable and usually requires a substantially greater amount of time before the external device can be removed. Our technique of tibial bone transport over an intramedullary nail using cable and pulleys combines internal and external fixation, allowing the external fixator to be removed at the end of the distraction phase. This increases the efficiency of limb reconstruction and decreases the external-fixator-associated complications. The procedure begins with thorough debridement, orthogonal tibial cuts, osteotomy, and insertion of a custom intramedullary nail. A 1.8-mm steel cable is wrapped around the anterior cortex of the distal end of the transport segment and exits the skin distal to the docking site. Two standard rings are app...Continue Reading

References

Mar 15, 2000·Journal of Orthopaedic Trauma·D Paley, D C Maar
Sep 30, 2005·Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association·Koji WatanabeKatsuro Tomita
Mar 20, 2008·Journal of Orthopaedic Trauma·S Robert RozbruchSvetlana Ilizarov
Sep 19, 2008·Clinical Orthopaedics and Related Research·S Robert RozbruchSvetlana Ilizarov
Mar 7, 2013·Archives of Orthopaedic and Trauma Surgery·Dietmar KrappingerBurkhart Huber
May 6, 2015·Clinical Orthopaedics and Related Research·Mitchell BernsteinS Robert Rozbruch

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Citations

May 1, 2020·The Journal of International Medical Research·Yao LuQian Wang
Apr 19, 2020·Journal of Orthopaedic Trauma·Ali BasSeckin Sari
Apr 5, 2021·The Journal of Arthroplasty·Leonid N SolominS Robert Rozbruch

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