Clinical Outcomes of Ilizarov Bone Transport for Distal Tibial Defects in Refractory Osteomyelitis: A Retrospective Study.

Background: Distal tibial defects following refractory osteomyelitis pose a significant orthopedic challenge, necessitating effective reconstruction. The Ilizarov bone transport technique is a potential treatment option, but its clinical outcomes specifically for distal tibial infectious defects need further evaluation.

Methods: In this retrospective observational single-arm study, we analyzed the clinical data of 22 patients who had undergone multiple debridements for refractory distal tibial osteomyelitis (DTO) and had associated bone defects, and were subsequently treated with the Ilizarov bone transport technique. Following debridement surgery, bone transport treatment was administered. Regular X-ray examinations, rehabilitation guidance, and follow-up were conducted to assess infection control, bone healing, limb function recovery, and complications. Therapeutic effects were evaluated using the Association for the Study and Application of Methods of Ilizarov (ASAMI), Visual Analog Scale (VAS) score, Activities of Daily Living (ADL) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score improvement.

Results: The mean follow-up was 29.32±20.92 months, with an average of 3.77±1.83 debridements. All bone defects healed, though 5 patients later required ankle arthrodesis. Complications included pin tract infection (n=10), axial deviation (n=3), ankle joint stiffness (n=2), non-union at the docking site (n=2), and delayed consolidation (n=2). At the last follow-up, ASAMI bone results: 15 excellent, 5 good, 2 poor (90.9% superiority rate). ASAMI functional results: 6 excellent, 14 good, 1 fair, 1 poor (90.9% superiority rate). VAS decreased from 4.86±0.83 to 0.5±0.66 (p<0.001). ADL improved from 80 (78.75-85) to 92.5 (90-95) (p<0.001). AOFAS score increased from 32 (25-38.25) to 82 (77-87.5) (p<0.001), with an 86.4% overall superiority rate.

Conclusion: Bone transport post - debridement is a valuable salvage for reconstructing distal tibial defects post-refractory osteomyelitis, with high safety, healing rate, and good efficacy. However, further comparative studies are warranted to confirm its advantages over other treatments.