Surgeons Increasingly Rely on Ilizarov Bone transport to Reconstruct Devastating Lower Leg Injuries
Complex, traumatic injuries to the distal tibia-the lower leg near the ankle-present a formidable challenge for orthopedic surgeons.When these injuries result in significant bone and soft tissue loss, conventional treatments often fall short, leaving patients facing potential amputation. However, a growing body of evidence highlights bone transport using the Ilizarov technique as a highly effective salvage procedure, restoring limb function and improving quality of life in these complex cases.
These severe injuries, frequently stemming from high-energy trauma like traffic accidents or gunshot wounds, impact a relatively small but critically affected population. Successful reconstruction isn’t merely about avoiding amputation; it’s about restoring mobility, reducing chronic pain, and enabling patients to return to work and daily activities. Ongoing research focuses on optimizing the Ilizarov technique, minimizing complications, and refining rehabilitation protocols to ensure the best possible outcomes for these patients.
A 2020 review by ianni D. Bone ( Biomed Res Int. 2020;2020(1):2716547) specifically addresses the needs of bone transport for traumatic composite tibial bone and soft tissue defects, reinforcing the Ilizarov technique as a cornerstone of treatment. While the Ilizarov method is central, surgeons are increasingly incorporating adjunctive techniques to enhance results. The “accordion technique,” combined with minimally invasive percutaneous decortication, has shown promise in treating bone non-unions (Qun Z, et al. Injury. 2017;48(10)). A 2024 systematic review by Zhiqiang R, et al. (J Orthop Surg Res. 2024;19(1)) further supports the combined use of Ilizarov and accordion techniques for long bone defects in the lower limbs.
Beyond these combined approaches, strategies to address specific challenges are emerging. For instance, Emara K and Allam M (J Trauma. 2008;65(3):685-691) describe a successful protocol of Ilizarov external fixation followed by intramedullary nailing for infected tibial nonunions. Oh C, et al. (Bone Joint J. 2013;95-B(12):1667-1672) advocate for bone transport with an external fixator and a locking plate for segmental tibial defects.
Despite it’s success, bone transport is not without potential complications. iacobellis C, et al.(Strate Trauma Limb Reconstruct. 2010;5(1):17-22) reviewed 100 consecutive cases, identifying common issues. Wang H, et al. (Medicine. 2017;96(45):e8569) investigated quality of life and complications at different stages of bone transport for infected tibial nonunions. A retrospective analysis of 282 cases over 10 years by Liu Y, et al. (BMC Musculoskelet Disord. 2020;21(1):354) further detailed the spectrum of complications associated with the Ilizarov method in the lower extremity.
A critical consideration during bone transport and limb lengthening is the impact on surrounding soft tissues, particularly skeletal muscle. Lindsey C, et al. (Clin Orthopaedics related Res. 2002;402(402):278-287) demonstrated the effect of the amount of limb lengthening on skeletal muscle, highlighting the need for complete rehabilitation programs to mitigate muscle atrophy and restore function.
