Tibial bone transport using external fixation in adults: a systematic review

Area of Science:

• Orthopedic surgery
• Regenerative medicine
• Biomaterials science

Background:

• Tibial bone transport with external fixation is a common technique for large tibial defects.
• Indications and surgical strategies are currently heterogeneous.
• The technique is demanding but reliable, with low failure rates and generally favorable outcomes.

Purpose of the Study:

• To systematically review the literature on tibial bone transport using external fixation.
• To synthesize data on patient demographics, surgical techniques, outcomes, and complications.
• To identify factors influencing treatment success and areas for standardization.

Main Methods:

• Systematic review conducted in April 2025, adhering to PRISMA guidelines.
• Searched PubMed/MEDLINE and Cochrane Library databases.
• Included data from 89 studies encompassing 3543 patients; assessed methodological quality using the MINORS score.

Main Results:

• Post-traumatic infection/osteomyelitis was the primary indication (58.5%).
• Mean defect length was 7.04 cm; bifocal transport and circular frames were common (82.4% and 79.0%, respectively).
• Mean external fixation time was 11.0 months, healing index 54.2 days/cm, with an overall failure rate of 0.9%.

Conclusions:

• Tibial bone transport with external fixation is a reliable reconstructive technique.
• Optimal outcomes depend on adequate soft-tissue management, selective docking-site grafting, and early functional rehabilitation.
• Further prospective studies are needed to standardize treatment strategies and improve clinical decision-making.