Early Postoperative Weight Bearing Following the Reconstruction of Traumatic Complex Tibial Bone Defects by Vascularized Free Fibula and Ilizarov External Fixator: A Case Series.

OBJECTIVE

Post-traumatic tibial bone defects represent a significant challenge to orthopedic surgeons. Various reconstructive methods are available based on associated local soft tissue injury and defect size. Free vascularized fibular graft represents a major successful technique; combined with a rigid Ilizarov external fixator, it allows safe, immediate postoperative weight bearing. In this article, we describe a series of six patients managed according to the previously presented plan, achieving satisfactory results.

METHODS

A series of six patients, all males with an average age of 33.3 years, underwent reconstruction for post-traumatic complex tibial bony defects using contralateral free vascularized fibular grafts and Ilizarov external fixation. Initially, all patients underwent multiple sessions of debridement and a simple pin-to-bar external fixator. The bony defect averaged 15 cm, and the average harvested length of the fibula used for reconstruction was 22.1 cm. All patients started immediate total weight bearing postoperatively, with a mean time of 17 days after bony union Ilizarov was replaced with minimally invasive plate osteosynthesis (MIPO) in all patients, and continued full weight bearing (FWB).

RESULTS

During the follow-up period, averaging 19.3 months, all patients achieved bony union with a mean time of 3.75 months. Patients spent an average of 6.4 months in the Ilizarov frame before it was replaced with MIPO; graft hypertrophy occurred in all patients, averaging 52.6%.

CONCLUSION

The combined use of a vascularized fibular bone graft and an Ilizarov frame proves to be a successful and safe approach for immediate postoperative FWB. This yields comparable outcomes in terms of union and function.