Citation Information :
Plotnikovs K, Kamenska J, Movcans J, Pasters V, Solomin L, Plaudis H. Artificial Deformity Creation as a Method for Limb Salvage for Patients with Massive Tibial and Soft Tissue Defects: A Report of 26 Cases. 2023; 18 (3):133-139.
Soft tissue and bone defects that occur consequence of high-energy trauma are serious and challenging problems. The aim of this retrospective cohort study is to show that the artificial deformity creation (ADCr) method allows the closure of soft-tissue defects, avoids amputation, and can facilitate the reconstruction of bone defects and restore limb length.
Patients and methods: Twenty-six adult patients (age range 20–81 years) with soft tissue defects of the lower limb were treated at the Riga East University Hospital from 2018 to 2021. All patients were treated using the ADCr method which is the technique of establishing an interim deformity for resolving tissue loss. The lower extremity functional scale (LEFS) and application of methods of ilizarov (ASAMI) criteria were used for the evaluation of bone healing and lower extremity function.
Results: Complete union was achieved in all cases. The functional evaluation showed that most patients could achieve excellent and good results and return to activities of daily living. The functional result was poor in one case of a multi-fragmentary distal tibial articular fracture for which an ankle fusion was performed. Final union in this case was achieved with some residual deformity.
Conclusion: The method of ADCr is an effective surgical technique in cases of severe tibial injuries with concomitant loss of bone and soft tissues. This method could be used in cases when either a plastic or microsurgeon is not available or for instances when closing the defect with a flap is either impossible or contraindicated. Excellent and good functional results are possible without severe complications.
Adamczyk A, Meulenkamp B, Wilken G, et al. Managing bone loss in open fractures. OTA Int 2020;3(1):e059. DOI: 10.1097/OI9.0000000000000059.
British Orthopaedic Association; British Association of Plastic Reconstructive and Aesthetic Surgeons. Audit Standards for Trauma: OPEN FRACTURES. 2017. Available from: https://www.nice.org.uk/guidance/NG37/chapter/recommendations.
Hernández-Irizarry R, Quinnan SM, Reid JS, et al. Intentional temporary limb deformation for closure of soft-tissue defects in open tibial fractures. J Orthop Trauma 2021;35(6):e189–e94. DOI: 10.1097/BOT.0000000000001988.
Lerner A, Fodor L, Soudry M, et al. Acute shortening Modular treatment modality for severe combined bone and soft tissue loss of the extremities. J Trauma 2004;57(3):603–608. DOI: 10.1097/01.ta.0000087888.01738.35.
Plotnikovs K, Ribakovs O, Movcans J, et al. A 52-Year-Old Man with a Gustilo-Anderson IIIB open tibial shaft fracture with extensive soft-tissue defect requiring limb salvage with artificial deformity-creating technique. Am J Case Rep 2022;23:e934788. DOI: 10.12659/AJCR.934788.
Sen C, Kocaoglu M, Eralp L, et al. Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss: A report of 24 cases. J Orthop Trauma 2004;18(3): 150–157. DOI: 10.1097/00005131-200403000-00005.
Plotnikovs K, Movcans J, Solomin L. Acute shortening for open tibial fractures with bone and soft tissue defects: Systematic review of literature. Strategies Trauma Limb Reconstr 2022;17(1):44–54. DOI: 10.5005/jp-journals-10080-1551.
Xu YQ, Fan XY, He XQ, et al. Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction experience from 31 cases. BMC Musculoskelet Disord 2021;22(1):34. DOI: 10.1186/s12891-020-03894-y.
Yushan M, Ren P, Abula A, et al. Bifocal or trifocal (double-level) bone transport using unilateral rail system in the treatment of large tibial defects caused by infection A retrospective study. Orthop Surg 2020;12(1):184–193. DOI: 10.1111/os.12604.
Poletti FL, Macmull S, Mushtaq N, et al. Current concepts and principles in open tibial fractures–part II management. MOJ Orthop Rheumatol 2017;8(2):00305. DOI: 10.15406/mojor.2017.08.00305.
Catagni MA, Azzam W, Guerreschi F, et al. Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects. Bone Joint J 2019;101-B(2):162–169. DOI: 10.1302/0301-620X.101B2.BJJ-2018-0340.R2.
Chan J, Harry L, Williams G, et al. Soft tissue reconstruction of open fractures of the lower limb muscle versus fasciocutaneous flaps. Plast Reconstr Surg 2012;130(2):284e–295e. DOI: 10.1097/PRS.0b013e3182589e63.
Gopal S, Majumder S, Batchelor AG, et al. Fix and flap The radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br 2000;82(7):959–966. DOI: 10.1302/0301-620x.82b7.10482.
Mullen JE, Rozbruch SR, Blyakher A, et al. Ilizarov method for wound closure and bony union of an open grade IIIB tibia fracture. Case Rep Clin Pr Rev 2004;5(1):1–6. Available from: http://www.crcpr-online.com/pub/vol_5/no_1/3389.pdf.
Salih S, Mills E, McGregor-Riley J, et al. Transverse debridement and acute shortening followed by distraction histogenesis in the treatment of open tibial fractures with bone and soft tissue loss. Strategies Trauma Limb Reconstr 2018;13(3):129–135. DOI: 10.1007/s11751-018-0316-z.
Solomin LN. The basic principles of external skeletal fixation using the Ilizarov and other devices, 2nd edition. Springer, Springer-Verlag 2012705–708. DOI: 10.1007/978-88-470-2619-3.
Manner HM, Huebl M, Radler C, et al. Accuracy of complex lower- limb deformity correction with external fixation: A comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop 2007;1(1):55–61. DOI: 10.1007/s11832-006-0005-1.
Eren I, Eralp L, Kocaoglu M. Comparative clinical study on deformity correction accuracy of different external fixators. Int Orthop 2013;37(11):2247–2252. DOI: 10.1007/s00264-013-2116-x.