A 55-year-old diabetic man with chronic osteomyelitis of the tibia undergoes debridement. The dead bone (sequestrum) is removed along with surrounding sclerotic bone. A large bone defect of 6 cm is created. Bone transport using a circular fixator (Ilizarov) is planned. This procedure is also known as:
- A Papineau technique (open cancellous bone grafting)
- B Bone transport (bifocal distraction osteogenesis using the Ilizarov frame) ✓
- C Masquelet induced membrane technique
- D Cancellous autograft with vascularized fibular strut graft
Explanation
For segmental bone defects >4–5 cm after debridement of chronic osteomyelitis, bone transport (bifocal distraction osteogenesis) using the Ilizarov circular fixator is a well-established method. A corticotomy is performed away from the infected zone; the intercalary segment is transported through the defect at 1 mm/day distraction until docking site contact. Bone transport is preferred for large defects in infected fields because it avoids placing graft material in an infected zone. The Masquelet technique uses an antibiotic spacer for 6–8 weeks to induce a vascularised membrane, then cancellous graft — useful for moderate defects (2–5 cm) in non-infected conditions. Papineau is open bone grafting after wound bed preparation.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.