Case Report Case of severe injury of lower limb treated with new Ljubljana traction method Dragica Smrke a, *, Zoran M. ArnezÏ b a Department of Traumatology, University Medical Centre, ZalosÏka 7, SI-1000, Ljubljana, Slovenia b Department of Plastic Surgery, University Medical Centre, ZalosÏka 7, SI-1000, Ljubljana, Slovenia Received 25 September 1998; accepted 9 February 1999 1. Introduction Large bone and soft tissue defects and post-trau- matic osteomyelitis can be treated by dierent surgical methods [1]. Cancellous bone grafting and reconstruc- tion by vascularised bone transfer along with the Ilizarov intercalary bone transport method are until now the most widely used methods for these types of injuries [2,3]. For the purpose of healing extremely large bone and soft tissue defects, a new Ljubljana traction system was constructed. It consists of a tubular AO-ASIF external ®xator on which a small metal traction device with teeth is placed (Fig. 1). This home constructed device can be manually handled. Each turn on the device represents 1 mm of traction of the living bone segment. The ¯exible wires are mounted on the living bone segment, which is later released with corticotomy. By rolling the wires on the traction device the released viable bone segment is pulled in the direction of the non-union. The system allows greater mobility of the patient and is suitable for patient management at home. 2. Case report A 22 year old male was admitted after previous treatment in another hospital, 13 days after a motor vehicle accident. On admission the patient had a 12 cm long tibial and extensive soft tissue defect with acute infection (Fig. 2). Before bifocal corticotomy [4] and initiation of viable bone traction (Fig. 3) several procedures were performed: angiography of the femoral artery, excision of dead tissue, sequestrectomy, insertion of an anti- biotic chain, external ®xation (that was exchanged twice), latissimus dorsi late free-¯ap transfer was made simultaneously after radical resection of necrotic and infected bone and soft tissue. The period from corti- cotomy to onset of distraction was 10 days proximally and 2 days distally. The lengths of the viable bone segments were 7 cm and 5 cm. Daily traction was 1.5 mm per day, bilater- ally. The period of traction was 38 days. Complications during traction were the following: recorticotomy proximally because of incomplete corti- cotomy, breakage of the traction wires and their im- mediate replacement, swelling in the area of the lower limb, and pain. Severe trophic skin lesions were not observed. After traction of the viable bone segment, cancellous bone grafting was necessary due to a residual bone defect of 1 cm between both viable bone traction seg- ments. After removal of the external ®xator additional plating was performed. The total period of healing before plate removal was 18 months. The plate was removed after 3.5 years, after complete bone healing. At 8 years the patient was satis®ed with the func- tional and aesthetic results (Fig. 4). Discrepancy in length of limb was not found and there is no need for any orthotic support. The knee is completely func- tional, but the ankle has 50% reduced function with respect to the healthy side. Injury, Int. J. Care Injured 30 (1999) 501±503 0020-1383/99/$ - see front matter # 1999 Elsevier Science Ltd. All rights reserved. PII: S0020-1383(99)00133-3 www.elsevier.com/locate/injury * Tel.: +386-61-143 14 19; Fax: +386-61-142 36 64. E-mail address: Smrke@mf.uni-lj.si (D. Smrke)