What is Bone Loss
Bone loss is defined as the discontinuity in a bone fragment which makes the limb frail and loses function. The bone is unable to perform any normal locomotor function and invariably the leg is the most affected area.
Bone loss can be from a small focal area to very large area which may measure up to 20 cms or more. These are called Non-Union lesions.
The common causes of bone loss are:
- High-velocity injuries
- Complex fractures
- Gun-shot injuries
- Crush injuries
- Bone infections
- Bone cancers
In order to rectify Bone Loss in patients, the bone transport procedure is used which is a common procedure based on the Ilizarov distraction of osteosynthesis. In this procedure, small healthy bone above or below the gap is cut and approximated with controlled distraction till the bone reunites with the existing healthy bone and the gap is consolidated. The controlled breaking of the bone is known as an “osteotomy” or “corticotomy”.
A variety of bone transport methods are available including:
- Forward transport
- Reverse transport
The procedure is, however, tedious and slow but yields very good results for Non-Unions.
In most cases, the overlying skin always has complications because of prior injury due to cancer, gun shot or Infections.
Many methods are available with variable success rates, however, Bone transport is one of the most successful methods to fill the Non-Union area.
Bone transport can be done with Ilizarov method as it holds he fragment very rigidly and in 3 dimensions so during transport the movement can be adjusted.
Patient with Giant Cell Tumor (GCT) before surgery
Bone Loss treated with Reverse Transport
Completion of transport process and formation of new bone
Final x-ray showing final results
An example of the external device used for bone transport