After successful bone transport across a 7 cm infected tibial defect, the transported segment meets the target segment, but at four months the docking site remains atrophic and ununited while the regenerate is solid. What is the most appropriate next step?

• A Resume compression-distraction across the docking site without grafting
• B Continue frame wear unchanged for another six months
• C Convert to a below-knee amputation
• D Autologous cancellous bone grafting of the docking site ✓

Explanation

Docking site nonunion is a recognised problem after bone transport because the two contacted surfaces are often sclerotic and avascular from prior infection and impaction. Once the regenerate is consolidated, the standard solution is freshening of the docking surfaces with autologous cancellous bone grafting, sometimes with secondary compression. Simply prolonging frame time rarely unites an atrophic docking site.

Reference: Chapman's Orthopaedic Surgery, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.