Background: Distal tibial reconstruction with use of an external
fixator when there is bone loss, limb-length discrepancy, and/or ankle
instability is associated with many problems. The technique of
limb-lengthening, ankle arthrodesis, and segmental transfer over an
intramedullary nail has been introduced to overcome these problems. The
present study investigates this combined technique.
Methods: Between 2002 and 2005, six patients, who ranged from
seventeen to seventy years old, underwent distal tibial reconstruction and
ankle arthrodesis with use of a circular external fixator and an
intramedullary nail to treat a distal tibial defect following resection for
chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined
with ankle instability. Functional and radiographic results were evaluated,
with use of the criteria described by Paley et al., at an average follow-up of
Results: The mean size of the bone defects in three patients was 5.3
cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four
patients was 5.25 cm (range, 4 to 6 cm). The mean external fixation time was
3.5 months, and the mean external fixator index was 0.57 mo/cm. There was no
recurrence of infection in the two patients with osteomyelitis. All six
patients had excellent bone results, and the functional results were excellent
for two patients and good for four patients. There were four complications,
three of which were categorized, according to Paley, as a problem (a
difficulty that occurs during lengthening and is resolved without operative
intervention) and one that was categorized as an obstacle (a difficulty that
occurs during lengthening and needs operative treatment).
Conclusions: The combined technique is an improvement over the
classic external fixation techniques of distal tibial reconstruction with
ankle arthrodesis. It reduces the duration of external fixation, thus
increasing patient acceptance, and it is associated with a low complication
rate facilitating more rapid rehabilitation.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.