Clinical Efficacy of Chess-Shaped Polymethyl Methacrylate–Ilizarov Technology for Severe Composite Tibial and Soft-Tissue Defects

This study evaluated the effectiveness of a combination technique for managing severe composite tibial and soft-tissue defects, without requiring complex soft-tissue procedures. A retrospective analysis was conducted on 33 patients with tibial and soft-tissue defects and Gustilo type IIIB open fractures treated between April 2017 and December 2023. The management protocol for all patients consisted of two stages. The first stage involved thorough debridement in the emergency department, removal of all free tibial bone fragments, and fixation with an external frame. The second stage involved Ilizarov bone transport, utilizing chess-shaped polymethyl methacrylate (PMMA) cement (thickness: approximately 1 cm) to fill the tibial bone defect. The PMMA was gradually removed until bone union was achieved. Bone union and soft-tissue healing were achieved in all patients, without the need for additional flap transplantation. The mean bone-union time was 7.5 ± 1.4 months, and the mean soft-tissue healing duration was 70.9 ± 24.1 days. The mean traction period was 105.3 ± 48.2 days, the mean external fixation time was 444.0 ± 137.2 days, and the mean external fixation index was 58.2 ± 23.1 days/cm. Using the Lower Extremity Functional Scale (LEFS) and 36-Item Short-Form Health Survey to evaluate functional scoring, the mean LEFS, physical health component, and mental health component scores were 59.8±13.9, 70.5±17.7, and 77.8±20.1, respectively. According to Paley's classification of complications, there were 14 problems, 6 obstacles, and no sequelae. The chess-shaped PMMA-Ilizarov technique effectively treated composite tibial and soft-tissue defects. This approach facilitated the gradual regeneration and repair of bone and soft-tissue defects, avoided the need for additional skin flap transplantation, and achieved satisfactory clinical results.