Surgical Choices for Segmental Bone Defect of the Tibia: Induced Membrane Technique with the Plate Versus Bone Transport Over the Plate

Purpose: Induced membrane technique (IMT) and bone transport (BT) are commonly used for the treatment of segmental bone defects of the lower limb. Conventionally, only an external fixator was used for both techniques, which had the disadvantage of many complications and a long healing period. This study tried to treat segmental defects of the tibia using IMT or BT with a plate, and analyzed and compared the results and complications.

Methods: 41 patients with segmental tibial defects greater than 5 cm who underwent surgical treatment with IMT or BT, with at least 1-year follow-up, were analyzed retrospectively. Only patients who used plates during surgery were included. The IMT group comprised 14 patients with a mean age of 51.5 years while the BT group comprised 27 patients with a mean age of 46.9 years. Mean defect sizes were 9.0 cm and 10.3 cm, respectively. There was no difference in patients in terms of the location and cause of the defect. Bony outcomes considering union, deformity, infection, and leg-length discrepancy were assessed. Functional outcomes were assessed by evaluating limping, joint stiffness, soft-tissue problem, pain, and daily life activity.

Results: The success rates of bone regeneration at the defect were 85.7% (12 of 14) in the IMT group and 85.2% (23 of 27) in the BT group, both of which were excellent. Postoperative infection rates were 28.6% in the IMT group and 29.6% in the BT group. Additional procedures including bone grafting to complete union were required in 1 patient in the IMT group and 6 in the BT group. Bony outcome greater than good was 78.6% (11 of 14) in the IMT group and 81.5% (22 of 27) in the BT group, which showed no significant difference. Functional outcome greater than good was 71.4% (10 of 14) in the IMT group and 77.8% (21 of 27) in the BT group, which showed no significant difference either. There were 2 cases of joint stiffness in the IMT group, whereas 9 cases were observed in the BT group (P = 0.021).

Conclusion: Both IMT and BT yielded successful bony and functional outcomes for the treatment of segmental tibial defects. However, BT required more additional procedures to obtain bone union and resulted in soft-tissue contracture around the joint due to the transport of the bone.