الفهرس 
Review of literatureOnly 14 pages are availabe for public view
 |  | from | 136 |  |  |
| | | from | 136 | | |
Abstract
Cases of post traumatic tibial nonunions due to bone loss or infected nonunions for which transport techniques are undertaken as a planned elective procedure. It becomes more complex when we has to deal with segmental defects following an acute traumatic situation. Fractures often will have extensive soft tissue loss with large bone defects. For these types of injuries, the principles of open fracture management must be adhered to prior to the institution of bone transport techniques.When considering bone transport in an acute or chronic situation, it is paramount to determine if a biologically sound healing environment is present or can be achieved at both the site of the proposed corticotomy and/or the docking sites. The success of both corticotomy and solid docking requires well vascularized segments of bone and soft tissue. If soft tissue compromised at the proposed corticotomy site, the production of healthy regenerate may be poor. Severe open fractures with a wide zone of injury are often associated with very poor soft tissue coverage at the site of injury.
The periosteal blood supply is derived primarily from the surrounding soft-tissue envelope. If this is inadequate and unable to provide a vascularized, viable periosteal sleeve, there will be development of an inadequate regenerate. In these situations, an alternative osteotomy site, performed through healthy tissues. Healing of the docking site needs to all the biologic components equivalent to an acute fracture. Revascularization of the docking segments and ability of the pluripotential cells migration is dependent on the revascularization process. If the docking fragments are excessively mobile, the moving bone ends effects on the local blood supply. Thus, the influence of a stable mechanical environment facilitates docking site union. This area must be manipulated to provide the appropriate vascular response either through aggressive debridement or through soft tissue coverage techniques.In cases of infected nonunions, draining sinuses with atrophic and scarred soft tissues are often present at the nonunion/proposed docking site. Consideration of these issues helps to determine the extent of nonviable tissue debridement necessary to obtain healthy vascular tissue.Our study included 30 patients with diaphysis or metaphysis tibial bone loss post traumatic were treated by ring fixator (ilizarov) started from March 2021 to February 2023, five patients were lost to follow-up. The remaining 25 patients were followed up for a period ranged from 9-12 months- Bone transport was done for 18 patients (8 patients posttraumatic -10 post infected nonunion)
- Acute Bone Shortening Followed by gradual Lengthening was done for 7 patients (2 patients posttraumatic -5 post infected nonunion)
The recommendation according to our study ;
1-acute bone shortening with gradual lengthening by ring fixator prefered in mild bone defect up to 3cm; avoiding docking site problems .2-segment bone transfer ; mainly for moderate to severe bone loss with advantage of short period fellow up in bifocal segment transfer but it needs enough segment proximal and distal to do double level of osteotomy .