Bone Transport

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Bone Transport

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Introduction to Bone Transport

Bone transport is a specialised orthopaedic procedure used to regenerate large segments of missing or damaged bone, most commonly in the limbs. This advanced surgical method is designed to restore bone continuity and limb function in cases where bone has been lost due to trauma, infection, tumour resection, or congenital conditions.

The cornerstone of this technique is the Ilizarov method, a world-renowned approach in orthopaedic surgery that facilitates bone growth through gradual mechanical distraction. With decades of clinical success, bone transport is now considered the gold standard for managing extensive bone defects, offering hope in even the most challenging cases.

When Is Bone Transport Needed?

Bone transport is considered when there is a segmental bone defect, typically:

  • Tibia: Defects > 3 cm
  • Femur: Defects > 5 cm

Common Indications:

  • Severe trauma with bone loss or open fractures
  • Chronic osteomyelitis (bone infection)
  • Post-tumour resection defects
  • Failed surgeries, including non-union or hardware failure
  • Congenital limb shortening or bone gaps

Deformity correction in previously untreated skeletal disorders

How Does Bone Transport Work?

The procedure involves several precise and coordinated steps:

  1. Preoperative Assessment: Imaging studies (X-rays, CT, MRI) are used to measure the bone defect and plan surgical intervention.
  2. Surgical Osteotomy: A controlled bone cut is performed away from the defect site to create a bone segment for transport.
  3. Application of the Ilizarov Frame: The circular fixator is installed externally, connected to the bone with fine wires and pins.
  4. Distraction Phase: The bone segment is gradually moved towards the defect at approximately 1mm per day.
  5. Regeneration: New bone forms in the gap created by distraction—this is known as the regenerate bone.
  6. Docking Site Union: Once the bone segment reaches the opposite end of the defect, it docks and begins to consolidate.
  7. Consolidation Phase: The new bone matures and strengthens, monitored via regular X-rays.

Frame Removal: Once healing is confirmed, the Ilizarov frame is removed, and rehabilitation begins.

Types and Approaches of Bone Transport

Depending on the size and location of the defect, different techniques are used:

  • Monofocal Transport: Single-site osteotomy and distraction.
  • Bifocal Transport: Involves two sites—shortens treatment duration.
  • Trifocal Transport: Utilised in very large defects; three active zones of bone regeneration.

Additional innovations include:

  • Single-level vs. multi-level distraction
  • Internal bone lengthening devices (in selected cases)

Hybrid approaches combining internal and external fixation

Indications for Bone Transport

Bone transport is typically recommended for:

  • Non-union of long bones after failed internal fixation
  • Infected non-union following debridement
  • Bone loss with soft tissue injury
  • Limb shortening with bone defect
  • Skeletal deformity correction alongside regeneration

Benefits of the Ilizarov Bone Transport Technique

This technique offers unmatched advantages in managing critical bone loss:

  • Bone Regeneration Without Grafts: This technique eliminates the requirement for donor bone or allografts.
  • Limb Length Preservation: Maintains or restores normal limb length and alignment.
  • Simultaneous Soft Tissue Healing: Enhances vascularity and allows concurrent soft tissue recovery.
  • Deformity Correction: Angular or rotational deformities can be corrected during the process.
  • High Success in Infected Cases: Post-debridement is particularly effective in cases of osteomyelitis.

Risks and Complications

As with any complex orthopaedic procedure, bone transport carries some risks:

  • Pin Site Infection: Requires regular care and early antibiotics.
  • Prolonged Treatment Time: May take several months.
  • Joint Stiffness: Especially in the knee or ankle.
  • Docking Site Issues: May need bone grafting.
  • Malalignment or Contractures
  • Patient Discomfort and Psychological Strain

Expert care and adherence to post-operative instructions can effectively manage these risks.

Recovery, Rehabilitation, and Aftercare

Patient involvement is crucial to successful outcomes.

  • Treatment Duration: Average of 1 month per 1 cm of bone transported.
  • Daily Distraction Adjustments: The Patient or caregiver turns the fixator’s adjusters as per schedule.
  • Physiotherapy: Essential to maintain joint mobility, prevent stiffness, and regain function.
  • Regular Imaging: To monitor regenerated bone and frame alignment.

Frame Removal: Done once consolidation is complete, followed by a gradual return to full weight-bearing.

Success Rates and Outcomes

Bone transport via the Ilizarov method has consistently shown:

  • Union rates above 90%
  • Excellent cosmetic and functional outcomes
  • Limb salvage in cases once thought irreparable

     

Patients treated by Dr. Divya Ahuja have reported restored mobility, pain relief, and return to daily activities—even in complex cases of trauma or infection.

Why Choose Dr. Divya Ahuja for Bone Transport Surgery?

Dr. Divya Ahuja is a pioneer in limb reconstruction and deformity correction, with extensive experience using the Ilizarov technique. His orthopaedic clinic offers:

  • Advanced surgical planning with digital tools
  • Customised treatment protocols
  • State-of-the-art Ilizarov and hybrid fixation systems
  • Comprehensive rehabilitation programs
  • Proven success in complex bone defects and infections

Book a Consultation with Dr. Divya Ahuja

If you or your loved one is facing a complex bone defect or has experienced failed surgeries, bone transport with the Ilizarov technique might be the definitive solution.

📞 Contact Dr. Divya Ahuja’s
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Frequently Asked Questions about Bone Transport

Some discomfort is expected, especially during distraction, but it is well-managed with pain medications and supportive care.

The process takes approximately one month per centimetre of bone defect, followed by consolidation. Total treatment may range from 6 to 12 months.

Alternatives include bone grafting, vascularized fibular grafts, or amputation in extreme cases. Bone transport is preferred for large defects.

If we maintain thorough debridement and proper frame care, recurrence is rare but still possible. Close monitoring is vital.

Yes, bone transport is especially suitable for children with open growth plates; however, planning must take future growth into account. Children typically heal faster than adults.

Partial weight-bearing is often possible with frame support, depending on the case. Full walking resumes after consolidation.

Small pin site marks may remain, but large scars are uncommon. Cosmetic results are usually very satisfactory.

In skilled hands, the success rate exceeds 90%, particularly when patients comply with follow-up and physiotherapy.

Yes, regular physiotherapy is essential to prevent joint stiffness and restore strength and mobility.

Yes, bone transport can be safely repeated or modified in case of recurrent defects or complications.

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