Vol. 6, Issue 1, Part A (2024)

Introduction: Loss of bone substance (LBS) in the limbs is serious and difficult to treat. Especially in our countries, which are characterized by a lack of technical, infrastructural and, above all, financial resources. The aim of this study is to describe our experience of reconstruction using an adapted external fixation and to evaluate our anatomical and functional results.
Patients and Methods: This was a retrospective, single-centre study of 6 patients managed between 2017 and 2022 in Douala, Cameroon. The mean age was 30, 5 years, there were 4 males and 2 females. The initial injury was an open fracture. In 1 case the PSO was caused by the trauma and in 5 cases by resection of osteitis. The mean size of the OSF was 9 cm, 5 times diaphyseal and 1 time distal diaphysometaphysal. According to Masquelet's classification, there were 3 cases of type 4 and 3 cases of type 3. Bone transfer was indicated after unsuccessful reconstruction using the Masquelet method in 1 case, the Papineau method in 1 case, and immediately after excision of osteitis in 4 cases. 1 medial gastrocnemius flap, 1 medial soleus flap with a distal pedicle, 1 posterior fasciocutaneous flap with a distal pedicle, and 1 posterior fasciocutaneous flap with a distal pedicle were used. In 5 of the 6 patients, 1 staphylococcus aureus was isolated 3 times, 1 Escherichia. Coli 1 time and 1 pseudomonas auruginosa 1 time. Surgery was performed on a standard table without image amplification. It involved a hybrid monoplane external fixture consisting of two fixators arranged as follows: a dynamic implant combined with a Hoffmann I fixator for patients 1 and 3 and a standard AO fixator for patient 2. Patient 4 had an external fixator consisting of 3 semi-circular rings. Patients 5 and 6 benefited from a rail-mounted monoplane external fixator. Radiographic and functional results were analysed using the Paley and Maar radiographic and functional scores. 
Results: Our follow-up was 46.5 months, the mean duration of transport was 3.96 months, and the mean size of the segment transported was 16.58 cm. The mean time to weight-bearing was 14.6 months. There were no regenerate fractures. The Paley and Maar functional score was excellent 3 times, good 2 times and poor 1 time. Monopodal weight-bearing was possible and pain-free. The Paley and Maar bone score was excellent 3 times, good 1 time and poor 1 time.
Conclusion: Reconstruction using segmental bone transport is a reliable, reproducible, and adaptable method. It gives satisfactory results in our context.