Complications Associated with Bone Transport Over a Plate for Segmental Tibial Defects: A Retrospective Review of 32 Cases.

Background: Although bone transport is a well-established technique for reconstructing segmental tibial bone defects, it is often associated with complications due to prolonged external fixation. Bone transport over a plate (BTOP) offers the advantage of reducing external fixation time, potentially lowering the complication rate compared to the traditional method. This study aims to evaluate BTOP-specific complications and their incidence in the treatment of tibial bone defects. Materials and Methods: A total of 32 cases (30 patients), with a mean age at the time of surgery of 47.1 years (range: 16-80), were included. All underwent the BTOP procedure between 2009 and 2023. Success or failure was determined by the bone healing status at both the distraction and docking sites. The ASAMI bony and functional outcomes were assessed at the latest follow-up. Complications were categorized as problems, obstacles, or sequelae. Results: The mean defect size was 7.9 cm. Procedural success was achieved in 28 cases, although 6 required additional surgeries. There were 4 cases of failure, all associated with deep infection. The mean duration of external fixation was 90.9 days, with a mean external fixation index of 12.8 days/cm. Twenty-five of the 32 cases showed excellent or good outcomes in both bony and functional assessments. A total of 45 complications were reported (22 problems, 9 obstacles, and 14 sequelae), with a mean of 1.41 complications per patient. Docking site nonunion occurred in 4 cases and was attributed to mechanical instability. Conclusion: BTOP appears to be a promising technique for reconstructing segmental tibial defects, offering a high success rate with reduced external fixation time and fewer complications. However, docking site nonunion remains a specific challenge of the BTOP technique, warranting further attention.