Bone transport for the management of severely comminuted fractures without bone loss.

This study aims to provide a new method for treatment of severely comminuted fractures without bone loss using the well-known technique of bone transport. Sixteen patients suffering from severely comminuted fractures with closed soft tissue injury were prospectively treated using bone transport by Ilizarov circular fixator. There were 14 male and 2 female patients. The mean age was 36.5 years (27-45). There were 13 proximal tibial metaphyseal fractures, one tibial diaphyseal fracture and two femoral distal metaphyseal fractures. All patients had closed soft tissue. The mean length of the comminution gap was 50.3 mm (40-64). Fracture healing occurred in 15 patients. The mean healing time was 23.4 weeks (14-30). No bone stimulating procedures were needed for either the fracture or distraction site. Using the IOWA knee and ankle score for assessment of the 15 patients who completed treatment: the functional outcome for the knee was excellent in 11 patients, good in three and fair in one. The ankle score was excellent in 12 patients, good in two and fair in one. According to Paley and Maar's, bone results were excellent in 14 patients, good in one patient and poor in the patient who had failure of the procedure. The results achieved in this work are encouraging to keep on applying this technique to treat fractures that meet the following criteria: metaphyseal, with total circumferential comminution involving more than 4 cm of the bone length.