Treatment of post-traumatic large tibial bone defects by Ilizarov external fixator: Bifocal and Trifocal bone transport.

Objectives: This study evaluates the efficacy and outcomes of bifocal bone transport (BFT) and trifocal bone transport (TFT) by Ilizarov external fixator in treating post-traumatic large tibial bone defects. Materials and Methods: Nineteen eligible patients with an average age of 30.5 ± 13.7 years (range 18–60 years) with post-traumatic tibial defects (more than 5 centimeters) who were admitted to our hospital from May 2020 to May 2022 were prospectively studied. Thirteen patients had bifocal bone transport, while the other six underwent trifocal bone transport. The demographic data, intraoperative outcomes, postoperative variables, exposure to secondary procedures, and complications in the two groups were recorded. Bone and functional results were evaluated using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Results: No difference was detected in the demographic data, and ASAMI bone and functional scores between both groups. However, the external fixation, distraction, and maturation indices were lower in TFT than in the BFT group, and secondary procedures were lower in TFT(50%) than in the BFT group (69.2%). Conclusions: Distraction osteogenesis by Ilizarov is an effective procedure for managing large post-traumatic tibial defects. Both BFT and TFT are safe, dependable, and effective methods for managing large bone and soft tissue defects in a single-stage surgery with highly satisfactory comparable results. TFT can significantly decrease the number of additional procedures and improve clinical results.