Ankle arthrodesis following bone transport as a definitive limb salvage strategy after multiple failed microsurgical reconstructions for infected tibial pilon fracture nonunion: a case report.

Reconstruction of large bone defects resulting from acute trauma, chronic osteomyelitis, or tumor resection remains one of the most challenging problems in orthopedic surgery. Historically, primary amputation was often considered the treatment of choice, particularly in fractures associated with extensive bone loss []. Over the past decades, however, the development of advanced reconstructive techniques has enabled limb salvage strategies aimed at restoring bone continuity while preserving limb length and function. Current treatment options for large bone defects include autologous bone grafting for defects smaller than 5 cm, the Masquelet induced membrane technique, acute shortening followed by gradual lengthening, and bone transport using external fixation based on the Ilizarov principles [–]. Among these strategies, bone transport through distraction osteogenesis has gained widespread acceptance, particularly in the management of complex, infected, and post-traumatic defects, owing to its ability to regenerate bone and surrounding soft tissues simultaneously. The Ilizarov method, introduced in the 1950s by Gavril Abramovich Ilizarov in the Soviet Union [], is based on the principle of controlled mechanical distraction to stimulate new bone formation. Distraction osteogenesis consists of four distinct phases: osteotomy, latency, distraction, and consolidation. Optimal outcomes have been reported when a low-energy corticotomy is followed by a latency period of 5–7 days, gradual distraction at approximately 1 mm per day, and stable external fixation []. Using this technique, bone segments of up to 20 cm can be successfully regenerated.