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Temporary spacer rod and plate technique: a novel intraoperative technical tip for minimizing the docking site malalignment during bone transport for bone loss in Gustilo IIIb open tibial fractures



Distraction osteogenesis is a safe and reliable option for managing bone defects of the tibia following major open fractures. Even though the Limb Reconstruction System (LRS) is a popular option, it may result in malalignment, necessitating an additional procedure to correct the alignment. The objective of the study is to assess the efficacy of a novel surgical technique in minimising malalignment.


This was a retrospective cohort study conducted at a level 1 tertiary trauma centre consisting of 35 patients with primary bone loss following open tibia fractures. A uniplanar LRS frame was applied using a combined spacer rod with plate technique. Radiological assessment of docking site characteristics (translation, angulation) and functional assessment using ASAMI score was done.


The mean distraction regenerate length was 8.4 ± 3.45 cm. At the docking site, 18 patients did not have any deformity, 13 had a minor deformity of ≤ 5°, 2 had a moderate deformity of 6°–10° and 2 with a severe deformity > 10°. Circumferential docking was seen in 88.5% (31/35). According to the ASAMI functional scoring, 13 patients had excellent outcomes, 19 had good, one had fair, and two had poor outcomes. Six patients had pin tract infections, three had deep infections, and 17 had a delayed union. Our study had a lower incidence of malalignment compared to similar studies in the literature.


The use of this simple and economical intra-operative technique allowed for much higher precision in aligning the fracture ends, thus minimising the docking site malalignment.

Level of evidence


Level of clinical care

Level I Tertiary trauma centre.

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr Dheenadhayalan Jayaramaraju and Dr Vasudeva Nagashree. The first draft of the manuscript was written by Dr Dheenadhayalan Jayaramaraju and Dr Vasudeva Nagashree. Dr Agraharam Devendra and Dr Rajasekaran Shanmuganathan revised it critically for intellectual content. All authors read and approved the final manuscript.

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Correspondence to Jayaramaraju Dheenadhayalan.

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Approval was obtained from the Institutional ethics committee. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study

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Dheenadhayalan, J., Nagashree, V., Devendra, A. et al. Temporary spacer rod and plate technique: a novel intraoperative technical tip for minimizing the docking site malalignment during bone transport for bone loss in Gustilo IIIb open tibial fractures. Eur J Trauma Emerg Surg (2022).

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  • Bone loss management
  • Limb lengthening
  • Distraction Osteogenesis
  • Tibial gu