Fragmental bone transport in conjunction with acute shortening followed by gradual lengthening for a failed infected nonunion of the tibia

Joint stiffness and limited bone stock for fixation were the main problems in management of periarticular bone defects. The present study aimed to report clinical and radiographic outcome of periarticular, large (≥8 cm) bone defects treated with ring external fixator.Seventeen patients (10 males and 7 females) who had periarticular bone loss at the minimum of 8 cm were treated with ring external fixator. Acute shortening and subsequent lengthening at the corticotomy site were performed in 5 patients. Bone transport was performed in 12 patients. Clinical outcome and radiographic outcome were reviewed.Seventeen patients (10 males and 7 females). Mean age was 31.1 years (9–52 years). Mean bone gap was 9.17 cm (8–14 cm.). Mean follow-up period was 39.7 months (30–60 months). Fracture united primarily in 14 cases and after iliac bone graft in 2 cases. One patient had nonunion. Based on ASAMI evaluation;The bone result was excellent, good, and poor in 13, 3, and 1 patients, respectively. The functional results were excellent and good in 14 and 3 patients respectively. Ten patients had superficial pin tract infection.Periarticular large bone defects were successfully treated with ring external fixator by bone transport or acute shortening and subsequent lengthening at corticotomy site. Superficial pin tract infection and joint stiffness were common problems in management of periarticular large bone defects. Early convert to internal fixation after achieve the acceptable length or after successfully bony contact of bone transport fragment to allowed early motion of the joint was recommend. Good to excellent functional outcomes were achieve in majority of the patients.