{'fraction_non_alphanumeric': 0.018645731108930325, 'fraction_numerical': 0.004906771344455349, 'mean_word_length': 4.8091168091168095, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Immediate bone transport: a novel technique for the management of bone defects after chronic osteomyelitis in children

An eight-year-old girl attended our institution with chronic osteomyelitis of the right tibia with destruction of the proximal tibia epiphysis. Two debridements were carried out three months apart leaving a 4 cm total and 4 cm partial bone defect in the tibia. Three months later, blood tests and radiographs confirmed the infection had been eradicated and our novel technique of immediate bone transport was carried out with transport of a 10-cm length of tibia into the defect zone. Our technique is performed by exposing the tibia down to a zone of healthy periosteum distal to the bony defect. The periosteum is then gently elevated circumferentially. An osteotomy is performed at least 10mm from the physis, allowing a section of tibia 10mm longer than the defect to be transported into the defect zone and docked in the stump with either an absorbable suture or buried Kirschner wires. This transposes the defect in the tibia to where the healthy bone has been transported from, surrounded by a healthy periosteal envelope (Figure 1). This periosteal sleeve is now the key to bone regeneration. The patient is then placed into an above knee cast and can be discharged home nonweight-bearing with crutches. Alternatively, where resources allow, the construct can be neutralised with a simple static circular frame and the patient allowed an appropriate level of weight-bearing. After six weeks, the cast is removed and radiographs are performed. The patient is allowed to bear weight on this limb partially once appropriate evidence of regeneration of the defect has been confirmed radiographically. In our cases, external splintage has not been required beyond three months. The child in this case was able to attend school, play and perform all activities of daily living pain-free and without support by six months. At the last review at four-year follow-up, there was bone union throughout the tibia (Fig. 2).