Matched Case-Control Comparison of Bone Transport Using External Fixator over a Nail versus External Fixator over a Plate for Segmental Tibial Bone Defects.

OBJECTIVE To compare the outcomes and complications of bone transport over a nail (BTON) with those of bone transport over a plate (BTOP) for segmental tibial bone defects. DESIGN Retrospective matched case-control study design. SETTING A major metropolitan tertiary referral trauma center. PATIENTS Thirty-six patients with segmental tibial bone defects of >4 cm. INTERVENTION Either BTON or BTOP was performed on 18 patients. MAIN OUTCOME MEASUREMENTS We compared the healing of the distraction process and of the docking site between the techniques. Distraction parameters including external fixator (EF) time, external fixation index (EFI), and healing index (HI) were compared. Bone and functional results were compared according to the Paley-Maar classification. Complications associated with each procedure were compared. RESULTS Both BTON and BTOP achieved similar rates of primary union (83% vs. 89%) at the distraction or docking site. Significantly less time wearing an EF was needed for BTOP than for BTON (2.8 vs. 5.4 months; p < 0.01). The EFI was significantly lower for BTOP than for BTON (0.45 vs. 0.94 months/cm; p < 0.01), whereas the HIs were similar. The final outcomes and complication incidences were not significantly different. CONCLUSIONS The EF time was significantly shorter for BTOP than for BTON; however, the final outcomes were similar. Therefore, BTOP could be considered an attractive option for bone transport in patients with segmental tibial defects. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.