Advertisement

HSS Journal

, Volume 5, Issue 1, pp 31–39 | Cite as

Ipsilateral Fibular Transport Using Ilizarov–Taylor Spatial Frame for a Limb Salvage Reconstruction: a Case Report

  • Raheel Shafi
  • Austin T. Fragomen
  • S. Robert RozbruchEmail author
 

Abstract

Segmental bone defects of the tibia present a challenging problem, particularly when they are associated with soft tissue injuries or instability. Various techniques have been reported to treat bone loss in the tibia. This case report describes a patient with massive segmental bone loss associated with a soft tissue injury, which required a flap for coverage. The injury was treated with an ipsilateral fibular transport utilizing an Ilizarov/Taylor spatial frame. At one and a half year follow-up, the patient was able to walk without any support at home and wore a protective shell for outdoor activities. The outcome of this case study indicates that ipsilateral fibular transport using the Ilizarov method is a valuable technique for limb salvage reconstruction.

Keywords

fibular transport segmental defect Taylor spatial frame (TSF) vascularized graft fibular hypertrophy Ilizarov 

Notes

Acknowledgment

The authors would like to thank Craig Fryman, BS (Research Coordinator).

References

  1. 1.
    Enneking WF, Eady JL, Burchardt H (1980) Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am 62:1039–1058PubMedGoogle Scholar
  2. 2.
    Huntington TW (1905) Case of bone transference. Use of a segment of fibula to supply a defect in the tibia. Ann Surg 41:249–251PubMedCrossRefGoogle Scholar
  3. 3.
    Chacha PB, Ahmed M, Daruwalla JS (1981) Vascular pedicle graft of the ipsilateral fibula for non-union of the tibia with a large defect: an experimental and clinical study. J Bone Joint Surg Br 63:244–253PubMedGoogle Scholar
  4. 4.
    Agiza AR (1981) Treatment of tibial osteomyelitic defects and infected pseudarthroses by the Huntington fibular transference operation. J Bone Joint Surg Am 63:814–819PubMedGoogle Scholar
  5. 5.
    Shapiro MS, Endrizzi DP, Cannon RM et al (1993) Treatment of tibial defects and nonunions using ipsilateral vascularized fibular transposition. Clin Orthop Relat Res 296:207–212PubMedGoogle Scholar
  6. 6.
    Hertel R, Pisan M, Jakob RP (1995) Use of the ipsilateral vascularised fibula for tibial reconstruction. J Bone Joint Surg Br 77:914–919PubMedGoogle Scholar
  7. 7.
    Date AS, Solanki SB, Badhe NP et al (1996) Management of gap non-union of tibia by tibialisation of ipsilateral vascular fibula. J Postgrad Med 42:109PubMedGoogle Scholar
  8. 8.
    Zahiri CA, Zahiri H, Tehrany F (1997) Limb salvage in advanced chronic osteomyelitis in children. Int Orthop 21:249–252PubMedCrossRefGoogle Scholar
  9. 9.
    Mankin HJ, Hornicek FJ, Raskin KA (2005) Infection in massive bone allografts. Clin Orthop Relat Res 432:210–216PubMedCrossRefGoogle Scholar
  10. 10.
    Wood MB (2007) Free vascularized fibular grafting—25 years' experience: tips, techniques and pearls. Orthop Clin North Am 38:1–12PubMedCrossRefGoogle Scholar
  11. 11.
    Carr AJ, Macdonald DA, Waterhouse N (1988) The blood supply of the osteocutaneous free fibular graft. J Bone Joint Surg Br 70:319–321PubMedGoogle Scholar
  12. 12.
    Mozzafarian K, Lascombes P, Dautel G (2008) Vascular basis of free transfer of proximal epiphysis and diaphysis of fibula: an anatomical study. Arch Orthop Trauma Surg (in press)Google Scholar
  13. 13.
    Atkins RM, Madhaven P, Sudhaker J et al (1999) Ipsilateral vascularized fibular transport for massive defects of the tibia. J Bone Joint Surg Br 81:1035–1040PubMedCrossRefGoogle Scholar
  14. 14.
    Goren D, Sapir O, Stern A et al (2005) Ipsilateral fibular transfer for a large tibial defect caused by a gunshot injury. Mil Med 170:418–421PubMedGoogle Scholar
  15. 15.
    Catagni MA, Ottaviani G, Camagni M (2007) Treatment of massive tibial bone loss due to chronic draining osteomyelitis: fibula transport using the Ilizarov frame. Orthopedics 30:608–611PubMedGoogle Scholar
  16. 16.
    May JW, Jupiter JB, Weiland AJ et al (1989) Current concepts review clinical classification of post-traumatic tibial osteomyelitis. J Bone Joint Surg Am 71:1422–1428PubMedGoogle Scholar
  17. 17.
    Minami A, Kasashima T, Iwasaki N et al (2000) Vascularized fibular grafts—an experience of 102 patients. J Bone Joint Surg Br 82-B:1022–1025CrossRefGoogle Scholar
  18. 18.
    Pederson WC, Person DW (2007) Long bone reconstruction with vascularized bone grafts. Orthop Clin North Am 38:23–35PubMedCrossRefGoogle Scholar
  19. 19.
    Mullen JE, Rozbruch SR, Blyakher A et al (2004) Ilizarov method for wound closure and bony union of an open grade IIIB tibia fracture. Case Rep Clin Pract Rev 5:70–75Google Scholar
  20. 20.
    Shane JN, Helfet DL, Rozbruch SR (2006) Temporary intentional leg shortening and deformation to facilitate wound closure using the Ilizarov/Taylor spatial frame. J Orthop Trauma 20:419–424CrossRefGoogle Scholar
  21. 21.
    Rozbruch SR, Adam M, Weitzman BA et al (2006) Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma 20:197–205Google Scholar
  22. 22.
    Rozbruch SR, Pugsley JS, Fragomen AT et al (2008) Repair of tibial nonunions and bone defects with the Taylor spatial frame. J Orthop Trauma 22:88–95PubMedCrossRefGoogle Scholar
  23. 23.
    Cattaneo R, Catagni M, Johnson EE (1992) The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 280:143–152PubMedGoogle Scholar
  24. 24.
    Sen C, Kocaoglu M, Eralp L et al (2004) Bifocal compression–distraction in the acute treatment of grade III open tibial fractures with bone and soft-tissues: a report of cases. J Orthop Trauma 18:150–157PubMedCrossRefGoogle Scholar
  25. 25.
    Ilizarov GA (1992) Pseudoarthroses and defects of long tubular bones: treatment of marked defects. In: Ilizarov GA (ed) Transosseous osteosynthesis. Springer, Berlin, pp 478–479Google Scholar
  26. 26.
    Lange RH (1989) Limb reconstruction versus amputation decision making in massive lower extremity trauma. Clin Orthop Relat Res 243:92–99PubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2008

Authors and Affiliations

  • Raheel Shafi
    • 1
  • Austin T. Fragomen
    • 1
  • S. Robert Rozbruch
    • 1
    • 2
    Email author
  1. 1.Limb Lengthening and Deformity ServiceHospital for Special Surgery, Weill Cornell Medical CollegeNew YorkUSA
  2. 2.New YorkUSA

Personalised recommendations