Balanced Cable Bone Transport to an Ankle Fusion With Automated Struts: Techniques and Case Review

Complex distal tibial injuries with segmental bone loss, joint destruction, and osteomyelitis present a formidable limb salvage challenge. A novel technique using circular external fixation with trifocal balanced cable transport combined with primary ankle arthrodesis is described. This technique allowed early weightbearing, soft tissue preservation, and alignment correction, while minimizing time in external fixation. Despite the risk of complications such as docking site nonunion and pin tract infections, adjunctive staged conversion to internal fixation mitigated these concerns. This report is the first to describe automated balanced cable trifocal transport with speed multiplier pulleys to the talus for ankle arthrodesis. The approach offers a powerful option for limb salvage in patients with complex distal tibial and osteochondral defects while minimizing external fixation time.