Fibula-Assisted Segment Transport (FAST) for Defect Reconstruction after Resection of Tibial Adamantinoma: Report of Two Treatments

Intramedullary limb lengthening via lengthening nails has been performed for more than three decades to overcome leg length inequalities. Plate-assisted bone segment transport (PABST) has recently been described for the reconstruction of segmental bone defects. We modified this procedure by using the ipsilateral fibula as a “biological plate” and report on its technical particularities and application in the reconstructive treatment of adamantinomas of the tibia in two patients. Both patients were successfully treated by wide resection and reconstruction of the tibial bone via bone segment transport through an expandable intramedullary nail using the remaining ipsilateral fibula to provide stabilization and guidance. This procedure was titled “fibula-assisted segment transport” (FAST). This is a new and promising technique that allows an entirely biological reconstruction of large bone defects of the tibia.

Bone transport with magnetic intramedullary nails in long bone defects

Background This study describes the outcomes of internal bone transport with magnetic nails in five cases of traumatic segmental femoral bone defects. Methods Five patients with open fracture of the femur and diaphyseal bone loss were included between May 2018 and August 2020. The mean femoral defect was 8.7 cm (range 5.6–16.0). Intervention We used plate-assisted bone segment transport (PABST) with PRECICE magnetic nails. Results All five patients have fully consolidated. The mean consolidation time and index were 7.5 months and 0.8 mo/cm, respectively. The mean follow-up was 21.3 months. The main complications were reduced knee ROM, mild varus deformity and plate bending. Post-operative SF-36, Oxford Knee scores and ED-5Q-5L scores were also compiled for four of five patients. SF-36 and Oxford Knee scores were reported without pre-injury data for comparison. ED-5Q-5L index and VAS were compared UK population norm and were both found to be statistically insignificant (p = 0.071 and p = 0.068, respectively). Conclusion Bone transport with magnetic nails has the capacity to obtain good functional recovery in long bone defects despite variable outcome pictures. In response to variable outcome reporting in the literature, we propose a standard reporting template for future studies to facilitate more rigorous analyses.