A comparison of external fixation alone or combined with intramedullary nailing in the treatment of segmental tibial defects.

The purpose of this study was to compare the results of external fixation alone versus external fixation combined with intramedullary nailing in the reconstruction of segmental defects of the tibia resulting from chronic osteomyelitis. Thirty-two patients were treated with external fixation alone and 17 patients with the combined technique. Surgical reconstruction utilised distraction osteogenesis by focal segment transport after infection was eradicated. In the external fixation group, the mean size of the defect was 724 cm, external fixation index was 56.32 days/cm and consolidation index was 40.09 day/cm. In the combined technique group, the mean size of the defect was 8.89 cm, external fixation index was 1631 days/cm and consolidation index was 25.7 days/cm. There was no difference in non-union, deformity, limb length discrepancy (LLD), bone and functional results. However, there was a higher rate of reinfection in the combined group when tibial lengthening exceeded 9.25 cm and lengthening ratio was more than 24.8%.