Comparison of bone transport and acute shortening methods in the treatment of gunshot defects of the tibial diaphysis

Introduction The use of high-precision, high-yield munitions in modern warfare has led to an increase in the number of wounded personnel with extensive defects of the tibial shaft. Effective methods for filling such defects are the methods of G.A. Ilizarov: bifocal or trifocal osteosynthesis with subsequent transport of fragments and (or) bone segments relative to each other (referred to as "bone transport method" in foreign literature), as well as acute, gradual, or combined shortening and subsequent lengthening.
Aim of the study: To compare the efficacy and safety of the bone transport (BT) method and the acute shortening with subsequent lengthening (ASL) method for filling (elimination) of gunshot defects of the tibial shaft.
Materials and methods The study included 60 male patients aged 18 to 59 years with gunshot defects of the tibial shaft ranging from 2 to 16 cm. They were divided into two groups comparable in main characteristics, depending on the treatment method applied. In the first group (30 subjects), the tibial defect was managed using the BT method, in the second group (n = 30) the ASL was applied.
Results In all patients of both groups, defects were eliminated, the length of the injured lower leg was restored, and the weight-bearing function of the limb was regained. According to the criteria of consolidation time at the docking site and maturation time of the regenerate, a statistically significant advantage of the ASL method was noted. The total treatment time and the external fixation index were greater in the BT group compared to ASL, but the differences were not statistically significant. The results on the ASAMI anatomical and functional scale were statistically significantly better in the ASL group. Substantial statistically significant differences between the groups were revealed in the number and types of minor and serious complications that developed during treatment. Non-union and invagination were observed only in the BT group. Differences regarding axis deviation of the segment and contracture of adjacent joints were not statistically significant.
Discussion The identified advantages of ASL are due to the absence of drawbacks that are characteristic of BT: prolonged absence of contact between bone fragments, technical difficulties and the long duration of moving a bone segment from one fragment to another and the necessity to achieve union simultaneously in two foci of bone damage (the defect zone and the regenerate zone).
Conclusion In the treatment of patients with gunshot defects of the tibial shaft, the use of BT and ASL methods ensured effectiveness with the possibility of achieving a positive result in up to 100 % of cases. The advantage of the ASL method in terms of safety indicators (type and number of complications) compared to BT was statistically significant.

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