Distraction of Longitudinally Split-Off Fragments With Ilizarov Method: A Report of Five Cases Treated for Partial Bone Defects

Introduction: The Ilizarov method is a recognized technique for managing complex skeletal injuries, offering comprehensive treatment for both bone and soft tissue components. While bone lengthening and transport are well-known technique, distraction of a longitudinally split fragment remained infrequent. Methods: This study presents a case series of five patients who underwent distraction of a longitudinally split fragment using the Ilizarov method between January 2006 and December 2022. Clinical information was collected from medical records, and surgical procedures were documented. Postoperative assessments were conducted through regular radiographic imaging. Results: The case series demonstrates successful reconstruction of partial bone defects resulting from trauma or osteomyelitis using this technique. Five patients (4M:1F) underwent surgery 4.8 to 34 months from the injury for a partial defect of the proximal tibia from 4 to 8 cm long. The direction of distraction was performed in different directions along sagittal and longitudinal axis. The external-fixation time range from 3.5 to 4.8 months, the external fixation index from 0.49 to 1.22. The ASAMI functional score at the last follow-up was excellent for all the five patients. The ASAMI bone score showed all excellent results except for one patient with residual equinus (good). No other complications are reported. Conclusion: The Ilizarov method provides a minimally invasive and comprehensive approach to managing partial bone defects, addressing both skeletal and soft tissue components simultaneously. Through longitudinal split of a fragment transport and distraction osteogenesis, this technique promotes bone and tissue regeneration avoiding bulky bone defect and more complex segmental bone transport.