Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 5, pp 653–660 | Cite as

Gradual fibular transfer by ilizarov external fixator in post-traumatic and post-infection large tibial bone defects

  • Mohammed Anter Meselhy
  • Mohamed Salah Singer
  • Abdelsamie M. Halawa
  • Gamal Ahmed Hosny
  • Adel H. Adawy
  • Osama M. Essawy
Trauma Surgery



Several reconstructive procedures have been used in management of large tibial bone defects including bone graft, bone transport (distraction osteogenesis) using various external fixators, and vascularized bone graft. Each of these procedures has its limitations and complications. The study describes gradual medial fibular transfer using Ilizarov external fixators in management of patients with large tibial defect, either following infection or trauma.

Patients and methods

Between May 2011 and June 2013, 14 patients were prospectively included in the current study. The inclusion criteria were large tibial defect due to trauma or infection with severe soft tissue compromise, and small or poor tibial bone remnants making bone lengthening difficult. Exclusion criteria were patients with vascular or nerve injuries. The average age of the patients was 31.64 (± 6.5) years. Medial fibular transfer was done for all patients using Ilizarov at a rate of 0.5 mm twice daily. Iliac bone graft was used in all patients after the transfer.


The average segmental bone defect of the tibia was (13.2 ± 2.6), ranging between 8 and 18.6 cm. Union was achieved in all patients with average fixator time was 32.42 (± 4.32) weeks. Average follow-up after removal of the fixator was 40.5 (± 6.9) months.


Gradual fibular transfer by Ilizarov external fixator is a reliable technique in management of post-traumatic and post-infection large tibial bone defects with good clinical outcome, and with few complications.


Tibial defect Illizarov Fibular transefer 



All authors did not receive any fund or research Grants.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to disclose.

Ethical approval

The study was approved by ethical committee of Benha University and were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. All patients signed an informed consent after clear explanation of the surgical procedure.


  1. 1.
    Peden M, Hyder A (2002) Road Traffic injuries are a global public health problem. Br Med J 324(7346):1153CrossRefGoogle Scholar
  2. 2.
    Mauffrey C, Barlow B, Smith W (2015) Management of segmental bone defects. J Am Acad Orthop Surg 23(3):143–153PubMedGoogle Scholar
  3. 3.
    Keating J, Simpson A, Robinson C (2005) The management of fractures with Bone Loss. J Bone Jt Surg Br 87(2):142–150CrossRefGoogle Scholar
  4. 4.
    Huntington T (1905) Case of bone transference. Use of a segment of fibula to supply a defect in the tibia. Ann Surg 41:249–251CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Catagni M, Camagni M, Combi A, Ottaviani G (2006) Medial fibula transport with the Ilizarov frame to treat massive tibial bone loss. Clin Orthop Relat Res 488:208–216CrossRefGoogle Scholar
  6. 6.
    Yokoyama K, Itoman M, Nakamura K, Tsukamoto T, Saita Y, Aoki S (2001) Free vascularized fibular graft vs. Ilizarov method for posttraumatic tibial bone defect. J Reconstr Microsurg 17(1):17–25CrossRefPubMedGoogle Scholar
  7. 7.
    Arai K, Toh S, Tsubo K, Nishikawa S, Narita S, Miura H (2002) Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg 109(7):2301–2306CrossRefPubMedGoogle Scholar
  8. 8.
    Yin P, Zhang L, Li T, Xie Y, Li J, Liu J, Zhang L, Zhang Q, Tang P (2015) Ipsilateral fibula transport for the treatment of massive tibial bone defects. Injury 46(11):2273–2277CrossRefPubMedGoogle Scholar
  9. 9.
    Al-Sayyad M (2015) Ipsilateral medial fibular transport using a circular external fixator for reconstruction of massive tibial bone defects in children and adolescents. Egypt Orthop J 50:25–30CrossRefGoogle Scholar
  10. 10.
    Shiha A, Khalifa A, Assaghir Y, Kenawey M (2008) Medial transport of the fibula using the Ilizarov device for reconstruction of a massive defect of the tibia in two children. J Bone Jt Surg Br 90(12):1627–1630CrossRefGoogle Scholar
  11. 11.
    Tuli S (2005) Tibialization of the fibula: a viable option to salvage limbs with extensive scarring and gap nonunions of the tibia. Clin Orthop Relat Res 431:80–84CrossRefGoogle Scholar
  12. 12.
    Kovoor C, Jayakumar R, George V, Padmanabhan V, Guild A, Viswanath S (2011) Vascularized fibular graft in infected tibial bone loss. Indian J Orthop 45(4):330–335CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Gulan G, Jotanović Z, Jurdana H, Sestan B, Rapan S, Rubinić D, Ravlić-Gulan J (2012) Treatment of infected tibial nonunion with bone defect using central bone grafting technique. Coll Antropol 36(2):617–621PubMedGoogle Scholar
  14. 14.
    Pederson W, Person D (2007) Long bone reconstruction with vascularized bone grafts. Orthop Clin North Am 38(1):23–35CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Mohammed Anter Meselhy
    • 1
  • Mohamed Salah Singer
    • 1
  • Abdelsamie M. Halawa
    • 1
  • Gamal Ahmed Hosny
    • 1
  • Adel H. Adawy
    • 1
  • Osama M. Essawy
    • 1
  1. 1.Orthopedic DepartmentBenha UniversityBanhaEgypt

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