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Efficacy comparison of double-level and single-level bone transport with Orthofix fixator for treatment of tibia fracture with massive bone defects

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The aim of this study was to evaluate the clinical and functional outcomes of patients with large post-traumatic tibial bone defects managed by double-level bone transport using the Ilizarov technique and compare it with one-level bone transport technique.


A retrospective cohort study was conducted on 26 patients with open tibial fracture from January 2010 to January 2017. All cases were Gustilo III. Depending on the site of osteotomy, the patients were divided into single-level (n = 13) and double-level groups (n = 13). The bone transport time, consolidation time of the distraction gap, docking site healing time, external fixation time, external fixation index, soft tissue defect area, soft tissue growth index, operating time, and surgical bleeding volume were recorded and compared between the two groups. Bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria.


The mean duration of follow-up was 28.5 ± 5.8 months (range 13–38 months) since the Orthofix fixator was removed, all patients achieved complete union in the docking site and consolidation in the regenerate bone; moreover, the wound was closed The mean bone defect length after debridement was 7.2 cm (range 5.8–9.0 cm) in single-level group vs. 10.7 cm (range 7.5–15.0 cm) in the double-level group (P < 0.05). The mean docking site healing time was 10.85 ± 1.52 months in the single-level group vs. 8.93 ± 2.29 months in the double-level group (P < 0.05); external frame time was 18.06 months (range 15–20 months) in single-level group vs. 12.71 months (range 9.5–16.0 months) in the double-level group (P < 0.05); external fixation index was 2.52 months/cm (range 2.15–2.94 months/cm) versus 1.22 months/cm (range 0.96–1.67 months/cm) in double-level group (P < 0.01); and soft tissue growth index was 0.29 months/cm2 (range 0.21–0.45 months/cm2) in the single-level group versus 0.62 months/cm2 (range 0.47–0.86 months/cm2) in the double-level group (P < 0.01). According to the ASAMI classification, the clinical and functional results in the double-level group were better than in the single-level group.


The Ilizarov technique of double-level bone transport with Orthofix external fixator can be used successfully to repair and reconstruct the tibial bone loss and accompanying soft tissue defect.

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This study has received funding from The Affiliated Hospital Of Southwestern Medical University and Southwestern Medical University.


This study was supported by the Southwestern Medical University and The Affiliated Hospital joint funding (Grant No. 2017-QB-15), the science research funding of The Affiliated Hospital Of Southwestern Medical University (Grant No. 2017-PT-44), and the science research funding of Southwestern Medical University (Grant No. 2017-ZRQN-112).

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Correspondence to Shi Shen or Naiqiang Zhuo.

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Li, Y., Shen, S., Xiao, Q. et al. Efficacy comparison of double-level and single-level bone transport with Orthofix fixator for treatment of tibia fracture with massive bone defects. International Orthopaedics (SICOT) 44, 957–963 (2020).

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