Distractive Osteosynthesis of Shin Bones In Case of Deficiency/Excess of Soft Tissue

The aim to study the features of callus formation in patients with the presence and absence of a local infectious process in the bone in case of deficiency/ excess of soft tissue.

Rationale. Due to the constant increase in the number of patients with complications of fractures of the shin bones (ostitis, osteomyelitis, false joint, infected false joint), there is a need to rationalize and improve their treatment methods.

Materials and Methods. In the course of a single-center retrospective study, 82 patients were selected. All this patients underwent tibial defect replacement using various methods at the Ilizarov Center. Timelimit from 2010 to 2024. When processing the primary documentation, 29 cases were excluded due to various reasons (the most common was the lack of final radiographs, because patients completed treatment at their place of residence). The average age of the remaining 56 patients was 42 years. Two main groups were obtained: 1- in which the bone fragment was transported to replace the defect while maintaining the segment length, and 2— segment shortening with following length restoration. The studied indicators in the groups were: the relative size of the defect (the ratio of the length of the defect to the original segment length), the volume of distraction regenerate, the minimum diameter of distraction regenerate in one of the radiographic projections, the ratio between minimum diameter and relative size of the defect, the morphometric type of distraction bone regenerate in Li Ru classifications and the age of the patient. The average defect value was 27.2% (minimum 12%, maximum 63%). All surgical procedures were performed by experienced surgeons. After the osteotomy the distraction was delayed for a 7-10 days , then the distraction mode was 1,0 mm/day until X-ray confirmation of the clear space between the fragments. Most of the patients were then discharged on an outpatient basis with the recommended distraction speed 0.5 mm/day.

Results. A check was carried out on the normality of the distribution of signs in all groups according to Shapiro-Wilk. Next, a comparison was performed for the reliability of differences between patients with the presence/absence of a local infectious process, who performed the same type of bone replacement method (either segment bone transport or shortening with following length restoration).Minimal statistically significant differences in age and type of Li regenerate were found in patients who underwent bone transport. There were no statistically significant differences in all other indicators in both groups. The resulting indicators for assessing distraction regeneration are its minimum diameter and the type of regenerate according to Ru Li, because of asymmetric load on the entire structure of the regenerate, even the presence of a large volume makes it impossible to carry out a functional load on the segment. The absence of the influence of a local infectious process in bone and soft tissues around on distractive neoosteogenesis has been statistically proven. After conducting a correlation analysis of the main indicators in both groups and comparing them, it was proved that distractive osteoneogenesis proceeds better in conditions of an excess of soft tissues, that is, with segment shortening with following length restoration.

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