Skip to main content
Log in

Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript



Although long bone defects may be treated by callus distraction, frequent complications arise from the long duration of external fixation. To reduce such complications, bone transport over an intramedullary nail (BTON) has been done for tibial bone defect.


In 12 patients (mean age, 46.1 years) of chronic osteomyelitis or bone defect, segmental transport was done using external fixator over an intramedullary nail. Prior to the index procedure, all patients had had serial debridements and five required myocutaneous or free flaps for covering of soft tissue defects. Using Mekhail’s criteria, functional results were evaluated.


The mean transported amount was 5.9 (range, 3.5–12) cm. The mean external fixation index was 26 days/cm, and healing index was 62.6 days/cm. The primary union of distraction and docking site was achieved in all, except for one failure in union at the docking site, which required another bone graft. Except for one patient with associated ankle injury, all had excellent or good functions. There was one recurrence of osteomyelitis and one procurvatum of the proximal tibia of 10°.


BTON may be a successful method in tibial reconstruction and allows patients to return to daily life earlier with relatively few complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others


  1. Cattaneo R, Catagni M, Johnson EE (1992) The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop 280:143–152

    PubMed  Google Scholar 

  2. Dendrinos GK, Kontos S, Lyritsis E (1995) Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. J Bone Joint Surg Am 77:835–846

    PubMed  CAS  Google Scholar 

  3. Freedman EL, Johnson EE (1995) Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop 315:25–33

    PubMed  Google Scholar 

  4. Gordon JE, Goldfarb CA, Luhmann SJ, Lyons D, Schoenecker PL (2002) Femoral lengthening over a humeral intramedullary nail in preadolescent children. J Bone Joint Surg Am 84:930–937

    PubMed  Google Scholar 

  5. Green SA, Dlabal TA (1983) The open bone graft for septic non-union. Clin Orthop 180:117–124

    PubMed  Google Scholar 

  6. Hofmann GO, Gonschorek O, Buhren V (1999) Segment transport employing intramedullary devices in tibial bone defects following trauma and infection. J Orthop Trauma 13:170–177

    Article  PubMed  CAS  Google Scholar 

  7. Ilizarov GA (1987) The principles of the Ilizarov method. Bull Hosp Joint Dis 48:1–11

    Google Scholar 

  8. Kabata T, Tsuchiya H, Sakurakichi K, Yamashiro T, Watanabe K, Tomita K (2005) Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss. J Trauma 58:1213–1222

    PubMed  Google Scholar 

  9. Kocaoglu M, Eralp L, Rashid HU, Sen C, Bilsel K (2006) Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. J Bone Joint Surg Am 88:2137–2145

    Article  PubMed  Google Scholar 

  10. Kristiansen LP, Steen H (1999) Lengthening of the tibia over an intramedullary nail, using the Ilizarov external fixator. Major complications and slow consolidation in 9 lengthenings. Acta Orthop Scand 70:271–274

    Article  PubMed  CAS  Google Scholar 

  11. Kristiansen LP, Steen H (2002) Reduced lengthening index by use of bifocal osteotomy in the tibia: comparison of monofocal and bifocal procedures with the Ilizarov external fixator. Acta Orthop Scand 73:93–97

    Article  PubMed  Google Scholar 

  12. Mankin HJ, Doppelt S, Tomford W (1983) Clinical experience with allograft implantation: the first ten years. Clin Orthop 174:69–86

    PubMed  Google Scholar 

  13. Mekhail AO, Abraham E, Gruber B, Gonzalez M (2004) Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma 56:368–378

    Article  PubMed  Google Scholar 

  14. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R (1989) Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop 241:146–165

    PubMed  Google Scholar 

  15. Paley D, Maar DC (2000) Ilizarov bone transport treatment for tibial defects. J Orthop Trauma 14:76–85

    Article  PubMed  CAS  Google Scholar 

  16. Raschke MJ, Mann JW, Oedekoven G, Claudi BF (1992) Segmental transport after unreamed intramedullary nailing. Preliminary report of a “Monorail” system. Clin Orthop 282:233–240

    PubMed  Google Scholar 

  17. Reckling FW, Waters CH (1980) Treatment of non-unions of fractures of the tibial diaphysis by posterolateral cortical cancellous bone grafting. J Bone Joint Surg Am 62:936–941

    PubMed  CAS  Google Scholar 

  18. Sangkaew C (2004) Distraction osteogenesis with conventional external fixator for tibial bone loss. Int Orthop 28:171–175

    Article  PubMed  Google Scholar 

  19. Song HR, Oh CW, Mattoo R, Park BC, Kim SJ, Park IH, Jeon IH, Ihn JC (2005) Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more. Acta Orthop 76:245–252

    Article  PubMed  Google Scholar 

  20. Vidyadhara S, Rao SK (2007) A novel approach to juxta-articular aggressive and recurrent giant cell tumours: resection arthrodesis using bone transport over an intramedullary nail. Int Orthop 31:179–184

    Article  PubMed  CAS  Google Scholar 

  21. Vidyadhara S, Sharath KR (2006) Prospective study of the clinico-radiological outcome of interlocked nailing in proximal third tibial shaft fractures. Injury 37:536–542

    Article  PubMed  CAS  Google Scholar 

Download references


This work was supported by BK 21 and BioMedical Research Institute grant, Kyungpook National University Hospital (2006).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Chang-Wug Oh.

Additional information

This study was conducted at Kyungpook National University Hospital, Daegu, South Korea.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oh, CW., Song, HR., Roh, JY. et al. Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia. Arch Orthop Trauma Surg 128, 801–808 (2008).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: