Strategies in trauma and limb reconstruction · 2026
Technical Report: Two-stage Approach for Limb Reconstruction in Open Tibial Fractures with Bone Loss or Infection Using Soft Tissue Flap Coverage, Bone Resection, and Frame-guided Mono- or Bifocal Corticotomy-based Bone Transport, Including Video Demonstration.
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Ianniello Sander V, Vancastell Thylane E, Muscat Joseph, Krkovic Matija
Аннотация
AIM AND BACKGROUND: Orthopaedic surgeons face a complex challenge in managing open fractures of the lower leg or infected bones with significant segmental bone loss. The aim of this technical guide and video demonstration is to describe and standardise a two-stage approach, combining bone resection, soft tissue reconstruction and bone transport using a Taylor spatial frame (TSF), as management for such injuries.
TECHNIQUE: We describe a two-stage surgical technique: In the first stage, all infected, potentially infected, or necrotic bone is meticulously resected, and soft tissue coverage is provided using either local or free flaps. After soft tissue recovery and infection/contamination eradication, a TSF is applied with uni- or bifocal corticotomies to facilitate bone transport for reconstructing segmental bone loss. Bone transport is guided by frame-specific software that instructs daily micro-adjustments, carried out by the patient in their home setting. Regular follow-up and radiographic imaging allow for re-adjustment of software parameters, if required. Technical considerations, indications and limitations of the approach are also discussed.
CONCLUSION: This technical guide outlines a detailed description of a staged reconstructive surgical approach to address open fractures of the lower leg with significant segmental tibial bone loss. Use of the TSF system allows multiplanar adjustment and reduced risk of mal- or non-union. The technique requires careful pre-operative planning and significant patient compliance and engagement due to the prolonged treatment duration.
CLINICAL SIGNIFICANCE: This guide and video demonstration highlight an effective surgical technique for the management of open tibial fractures that utilises precision and advanced technology-guided frame adjustments.
TECHNIQUE: We describe a two-stage surgical technique: In the first stage, all infected, potentially infected, or necrotic bone is meticulously resected, and soft tissue coverage is provided using either local or free flaps. After soft tissue recovery and infection/contamination eradication, a TSF is applied with uni- or bifocal corticotomies to facilitate bone transport for reconstructing segmental bone loss. Bone transport is guided by frame-specific software that instructs daily micro-adjustments, carried out by the patient in their home setting. Regular follow-up and radiographic imaging allow for re-adjustment of software parameters, if required. Technical considerations, indications and limitations of the approach are also discussed.
CONCLUSION: This technical guide outlines a detailed description of a staged reconstructive surgical approach to address open fractures of the lower leg with significant segmental tibial bone loss. Use of the TSF system allows multiplanar adjustment and reduced risk of mal- or non-union. The technique requires careful pre-operative planning and significant patient compliance and engagement due to the prolonged treatment duration.
CLINICAL SIGNIFICANCE: This guide and video demonstration highlight an effective surgical technique for the management of open tibial fractures that utilises precision and advanced technology-guided frame adjustments.