Strategies in Trauma and Limb Reconstruction最新文献

{"title":"Early Experience of Femoral Lengthening with the FITBONE Nail in Adolescents.","authors":"Bartosz Musielak, Aubrey Franco, Nick Green, Stephen Giles, Sanjeev Madan, James A Fernandes","doi":"10.5005/jp-journals-10080-1655","DOIUrl":"10.5005/jp-journals-10080-1655","url":null,"abstract":"<p><strong>Aim and background: </strong>Intramedullary limb lengthening nails are increasingly used in patients nearing skeletal maturity. Following the temporary withdrawal of magnetically driven systems, the electrically powered FITBONE nail has been used at our institution since March 2021. This study aims to present the early experience of this nail with particular attention to complications, regenerative healing, and the learning curve.</p><p><strong>Materials and methods: </strong>A single-center retrospective study was performed, including adolescent patients who underwent femoral lengthening with antegrade or retrograde FITBONE nails and progressed to full weight-bearing (FWB). Outcome measures included length gained, distraction index (DI), weight-bearing index (WBI), mechanical axis parameters, complications, and patient-reported outcomes using the Paediatric Quality of Life (PedsQL) Questionnaire.</p><p><strong>Results: </strong>A total of 15 (eight males, seven females) patients with a mean age of 16.9 years, with varied diagnoses of leg length discrepancy (LLD), were analysed. Mean length gained was 39 mm with a mean DI of 0.75 mm/day. Weight-bearing index in these patients, on average, was 57.4 days/cm lengthened. Four complications were observed, including two nonunions (both successfully treated) and two knee subluxations. Mechanical axis deviation improved from 12.1 to 7 mm on average. A significant reduction in WBI was observed with increasing surgical experience (Spearman's ρ = -0.58, <i>p</i> = 0.02). No significant changes were detected in PedsQL scores pre- and post-operatively (<i>p</i> > 0.05 for all domains).</p><p><strong>Conclusion: </strong>Femoral lengthening using the FITBONE nail in adolescents approaching skeletal maturity is an effective and relatively safe procedure, with complication rates and outcomes comparable to other intramedullary lengthening systems. A learning curve was evident, reflected by earlier progression to FWB without an increase in complications.</p><p><strong>Clinical significance: </strong>Surgeons experienced with intramedullary limb lengthening can expect outcomes and complication profiles comparable to other motorised nail systems when using FITBONE. However, the relatively large barrel diameter (12 mm) may limit its use in patients with narrow femoral canals and should be considered during patient selection.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"135-140"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Proposal for the Kubicek-Ferreira Modification of the Gustilo-Anderson Classification: Eliminating the Clinical Ambiguity of Grade II and IIIC Open Tibia Fractures.","authors":"Juraj George Kubicek, Nando Ferreira","doi":"10.5005/jp-journals-10080-1657","DOIUrl":"10.5005/jp-journals-10080-1657","url":null,"abstract":"<p><p><b>How to cite this article:</b> Kubicek JG, Ferreira N. A Proposal for the Kubicek-Ferreira Modification of the Gustilo-Anderson Classification: Eliminating the Clinical Ambiguity of Grade II and IIIC Open Tibia Fractures. Strategies Trauma Limb Reconstr 2025;20(3):191-192.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"191-192"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged Reconstruction of Distal Femoral Osteosarcoma in a 10-year-old Girl using a Hybrid Endoprosthesis-Motorised Lengthening Nail Construct: A Case Report.","authors":"Frank Bevacqua, Lucas Annabell, Stewart Morrison","doi":"10.5005/jp-journals-10080-1661","DOIUrl":"10.5005/jp-journals-10080-1661","url":null,"abstract":"<p><strong>Background: </strong>Reconstruction of tumour defects in skeletally immature patients poses a particular challenge due to the resection of growing physes and resulting limb-length discrepancies. Expandable prostheses allow outpatient lengthening with fewer surgical revisions, but the limb is lengthened within the prosthesis rather than native bone.</p><p><strong>Case description: </strong>A 10-year-old girl with no medical history presented with distal right thigh pain and swelling. Imaging and biopsy confirmed osteosarcoma. She underwent wide local excision and initial endoprosthetic reconstruction, followed by a planned staged exchange to a hybrid endoprosthesis (BioXpand), in which the usual prosthetic stem is replaced by a motorised intramedullary nail (Fitbone), allowing limb lengthening via distraction osteogenesis. The patient began non-invasive lengthening on postoperative day five (approximately 0.96 mm/day), with the rate adjusted weekly based on clinical and radiological parameters. After 12 weeks, 6 cm of length was achieved, and consolidation took a further 6 weeks before full weight-bearing. Finally, the reconstruction was converted into a definitive static prosthesis once the final limb length was achieved. At the latest follow-up, the patient attends school and participates in sports, reports no pain, and is skeletally mature, with a 1-centimetre leg-length difference.</p><p><strong>Conclusion: </strong>This case demonstrates the feasibility of a staged approach to the reconstruction of paediatric osteosarcoma by combining the principles of endoprosthetic reconstruction with distraction osteogenesis. A staged strategy enabled oncologic clearance, growth accommodation, and functional preservation.</p><p><strong>Clinical significance: </strong>Staged BioXpand reconstruction offers a 'bioexpandable' alternative to expandable endoprostheses by restoring length through distraction osteogenesis rather than metal extension. A modular sequence (primary reconstruction, hybrid nail exchange for outpatient lengthening, then definitive static conversion) can equalise limb length while generating bone stock, supporting future revisions.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"186-190"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bifocal Lengthening with Monorail External Frame for Severe Shortening of the Femur: A Case Report.","authors":"Giuseppe Geraci, Vitantonio Digennaro, Riccardo Ferri, Federico Ruta, Antonio Mazzotti, Alberto Di Martino, Cesare Faldini","doi":"10.5005/jp-journals-10080-1660","DOIUrl":"10.5005/jp-journals-10080-1660","url":null,"abstract":"<p><strong>Aim and background: </strong>Femoral lengthening using a monorail external frame often involves creating two simultaneous distraction sites. This approach allows for a better distribution of the osteogenesis process and can reduce the overall treatment duration, particularly in cases of severe shortening. However, the literature on bifocal femoral lengthening is limited, with reported cases rarely exceeding 10 cm of lengthening. This case report aims to describe the treatment and outcome of a patient who underwent bifocal lengthening with a monorail external frame for severe femoral shortening.</p><p><strong>Case description: </strong>A 26-year-old female presented with a 23 cm shortening of the left lower limb resulting from previous surgeries for infection. She underwent bifocal femoral lengthening using a monorail external frame, achieving 20 cm of lengthening. Following the removal of the external fixator, a fracture occurred in the regenerated bone, necessitating intramedullary nailing.</p><p><strong>Conclusion: </strong>For severe femoral shortening, various lengthening techniques can be considered. Bifocal lengthening with a monorail external frame offers specific advantages and disadvantages that should be evaluated based on factors such as required treatment duration, expected patient compliance, and infection risks.</p><p><strong>Clinical significance: </strong>This case demonstrates that substantial femoral lengthening may be achievable with a monorail external frame, especially when two simultaneous osteotomies are utilised. For large bone regenerates, even with radiographic evidence of callus maturation, internal stabilisation may be advisable, despite the peculiar technical challenges involved.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"181-185"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary: Ambiguity, Biology, and Caution in Open Tibial Fractures.","authors":"Paul Harwood","doi":"10.5005/jp-journals-10080-1669","DOIUrl":"10.5005/jp-journals-10080-1669","url":null,"abstract":"<p><p><b>How to cite this article:</b> Harwood P. Editorial Commentary: Ambiguity, Biology, and Caution in Open Tibial Fractures. Strategies Trauma Limb Reconstr 2025;20(3):193.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"193"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Masquelet Technique: Is Bone Regeneration Influenced by Biological Sex?","authors":"Jasper Frese, Julius J Hahne, Cornelius Grimme, Ulf-Joachim Gerlach, Arndt P Schulz, Sidney Schaeffer","doi":"10.5005/jp-journals-10080-1649","DOIUrl":"10.5005/jp-journals-10080-1649","url":null,"abstract":"<p><strong>Purpose: </strong>Existing studies predominantly represent male patients, and no gender-specific analysis has been performed on treatment outcomes. This study aimed to investigate the influence of sex on the therapeutic outcomes of the Masquelet technique.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included 58 women and 113 men treated with the Masquelet technique at the BG Klinikum Hamburg (BGKH) between July 2011 and June 2021. No sex-specific treatment protocols were employed at BGKH. The defect location and size, indication for the Masquelet technique, occurrence of complications and surgical revisions, microbial colonisation of the defect site, secondary stabilisation strategies, as well as the achievement and time to full weight-bearing were systematically assessed.</p><p><strong>Results: </strong>The analysis revealed no significant difference in the percentage of patients achieving full weight-bearing capacity between male and female cohorts (<i>p</i> = 0.611). Specifically, 90.3% of men and 87.9% of women attained full weight-bearing capacity. The time to achieve full weight-bearing capacity averaged 21 months for both sexes. The complication rates were not significantly different, with 57% for men and 50% for women (<i>p</i> = 0.422).</p><p><strong>Conclusion: </strong>Fundamental factors such as age, comorbidities, defect size, and defect localisation did not substantially differ between male and female patient cohorts in this study. Consequently, the results suggest that biological sex does not exert a discernible influence on the therapeutic outcomes of the Masquelet technique.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"173-180"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporary Internal Stabilisation of Critical Long-bone Defects: A Strategy for Staged Limb Reconstruction.","authors":"Maksym V Baida, Serhii O Derkach, Rostyslav R Zilnyk, Vladyslav I Povkh","doi":"10.5005/jp-journals-10080-1664","DOIUrl":"10.5005/jp-journals-10080-1664","url":null,"abstract":"<p><strong>Background and aims: </strong>Critical long-bone defects remain among the most demanding problems encountered in orthopaedic trauma and reconstructive surgery. These defects arise from a variety of causes-high-energy trauma, blast injuries, bone infection, or oncological resection-and their management almost always demands a staged approach involving infection control, soft-tissue handling, and eventual restoration of skeletal continuity. A fundamental challenge throughout this process is keeping the affected limb mechanically stable between the initial operation and the definitive reconstructive procedure. External fixation has long served this role, since it stabilises the limb without introducing implants into potentially infected territory. However, prolonged reliance on external fixation is associated with several disadvantages: Patient discomfort, pin-tract infection, limited functional activity, and practical difficulties when soft-tissue reconstruction is subsequently needed.</p><p><strong>Patients and methods: </strong>A conceptual analysis of current stabilisation strategies for critical long-bone defects was performed, including external fixation and internal fixation methods. Particular attention was given to the biomechanical conditions present in large segmental defects, where a three-component system-bone, spacer, and fixation construct-determines overall stability.</p><p><strong>Results: </strong>Standard internal fixation methods are similarly constrained when large segmental defects are present. Placing permanent implants in an infected bed risks sustaining or reactivating infection, which is rarely an acceptable trade-off at the early stages of reconstruction. Stabilisation in the setting of a large segmental defect also operates under different mechanical conditions than a simple fracture. Here, the construct must manage not just two bone ends and a fixator, but a three-component system-bone, spacer, fixator-in which the spacer occupying the defect zone is an active mechanical participant. Stability depends on how all three elements interact, not on the fixator alone.</p><p><strong>Conclusion: </strong>In this conceptual paper, we introduce temporary internal stabilisation (TIS) as a distinct framework in the staged management of critical long-bone defects. Temporary internal stabilisation describes the use of internal constructs that provide mechanical stability and preserve limb alignment and length during the period between the first operation and the definitive reconstruction. We argue that this approach can meaningfully extend the options available in reconstructive orthopaedics and offers a fresh conceptual lens through which complex bone defects can be approached.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"167-172"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Bony and Soft Tissue Stabilisation of the Hip in Congenital Femoral Deficiency.","authors":"Ketan Dhital, Stephen Giles, James A Fernandes","doi":"10.5005/jp-journals-10080-1656","DOIUrl":"10.5005/jp-journals-10080-1656","url":null,"abstract":"<p><strong>Aim: </strong>This is a review of 23 patients with congenital femoral deficiency treated between 1999 and 2016 using a strategy of hip and femoral reconstruction before planned limb lengthening.</p><p><strong>Materials and methods: </strong>Standard radiological parameters describing proximal femoral and acetabular shape were used to record the preoperative and postoperative status. The neck-shaft angle, acetabular index, the Sharp-Ullmann index, and the Centre-Edge Angle of Wiberg were used. These results were analysed with regard to hip subluxations and other complications that had occurred during lengthening. All patients had completed their treatment cycles with no further lengthening procedures planned.</p><p><strong>Results: </strong>The neck shaft angles (NSAs) had a preoperative mean value of 89.3°, which, after reconstruction, was increased to a mean of 119.5° (<i>p</i> < 0.0001). The mean acetabular index of the affected limbs was 31.2° pre-operatively and improved to 17.1° post-reconstruction (<i>p</i> = 0.0003). The Sharp-Ullmann Index was reduced from 50.0° to 44.9° post-operatively (<i>p</i> = 0.0005). The mean CEA on the affected limbs of the patients was 25.9° post-operatively. There were no hip subluxations recorded during the subsequent lengthening procedures. Three patients required revision surgery to the hip and two cases of implant failure.</p><p><strong>Conclusion: </strong>These results suggest that addressing the pathoanatomy of the hip joint, via bony and soft tissue reconstruction, is of paramount importance in avoiding hip subluxation and dislocation during subsequent limb lengthening.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"141-146"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parents' Lived Experiences during their Child's Ilizarov Treatment: A Qualitative Study from a Tertiary Paediatric Orthopaedic Centre in India.","authors":"Sitanshu Barik, Denish Chandrakar, Piyush Chauhan, Saurabh Sah, Samir C Dwidmuthe","doi":"10.5005/jp-journals-10080-1662","DOIUrl":"10.5005/jp-journals-10080-1662","url":null,"abstract":"<p><strong>Background: </strong>Circular external fixation using the Ilizarov method is widely used in paediatric orthopaedics for deformity correction and limb reconstruction. Although clinical outcomes are well documented, the psychosocial and caregiving experiences of families during prolonged frame treatment remain underexplored, particularly in low- and middle-income settings. This study aimed to explore parents' lived experiences during their child's treatment with a circular external fixator.</p><p><strong>Methods: </strong>A qualitative exploratory study was conducted in the paediatric orthopaedic unit of a tertiary care teaching hospital in central India. Parents or primary caregivers of children undergoing or recently completing Ilizarov treatment were recruited using purposive maximum-variation sampling. Data were collected through semi-structured, in-depth interviews and analysed using reflexive thematic analysis following Braun and Clarke's approach. Rigour was enhanced through investigator triangulation, reflexive journaling, and the maintenance of an audit trail.</p><p><strong>Results: </strong>Twelve parents participated in the study. Six major themes emerged: Confronting the diagnosis, trust in the healthcare team, caregiving burden during the frame period, financial and travel hardship, emotional coping strategies, and recovery with reflection. Parents initially experienced fear and uncertainty but gradually adapted to the demands of frame care. Trust in clinicians and family support were key factors facilitating coping.</p><p><strong>Conclusion: </strong>Ilizarov treatment places considerable psychosocial and caregiving demands on families. Strengthening family-centred care, including structured counselling and caregiver education, may improve treatment experiences for children undergoing limb reconstruction.</p><p><strong>Clinical significance: </strong>Understanding caregiver experiences during Ilizarov treatment highlights the substantial psychosocial, logistical, and financial burden on families. Incorporating structured pre-treatment counselling, caregiver training, and family-centred support strategies may improve treatment adherence, reduce complications, and enhance overall patient and caregiver outcomes in paediatric limb reconstruction.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"160-166"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motorised Intramedullary Bone Transport: A Scoping Review.","authors":"Edward J Füzy, Jayesh D Haribhai, Nando Ferreira","doi":"10.5005/jp-journals-10080-1659","DOIUrl":"10.5005/jp-journals-10080-1659","url":null,"abstract":"<p><strong>Background: </strong>Segmental bone defects present a significant reconstructive challenge in orthopaedic surgery and are traditionally reconstructed using external fixation. The advent of motorised intramedullary bone transport nails (BTNs) aims to mitigate complications associated with external fixation. Despite the theoretical advantages, the clinical efficacy and complication profile of BTNs remain unclear. This scoping review evaluates the current literature on the use of BTNs in segmental bone defect reconstruction.</p><p><strong>Methodology: </strong>A search of PubMed, Google Scholar, and Cochrane Library databases was conducted following the PRISMA-ScR guidelines. Studies published between 2010 and 2024 that reported on motorised BTNs were included. Data extraction focused on patient demographics, defect characteristics, treatment strategies, complications, consolidation indices, and functional outcomes. Due to study heterogeneity, results were synthesised descriptively.</p><p><strong>Results: </strong>Fifteen studies were included, comprising three retrospective cohorts, seven case series, and five case reports, totalling 61 patients. Most defects occurred in the femur (60.7%), with trauma (39.3%) as the most common aetiology. The mean defect size was 7.1 cm (range: 0.5-17 cm). The overall union rate was 92.3%, with a mean bone healing index (BHI) of 51.36 days/cm. A total complication incidence of 106.6% was reported, reflecting multiple complications in some patients, with device-related failures (22%), joint contractures (14%), and delayed union (9%) as common occurrences. While BTNs eliminate external fixation-associated morbidity, they introduce unique challenges such as mechanical failures and prolonged periods of non-weight-bearing. Patient-reported outcomes (PROMs) were rarely assessed, with only two studies reporting functional scores.</p><p><strong>Conclusions: </strong>Motorised intramedullary bone transport offers a promising alternative to external fixation, particularly for femoral defects. However, BTNs introduce device-specific complications and remain costly and technically demanding. Current evidence is limited to small case series with heterogeneous methodologies, precluding definitive conclusions on superiority over external fixation. Future research should focus on multi-centre comparative studies with standardised outcome measures to establish the optimal role of BTNs in limb reconstruction.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"20 3","pages":"153-159"},"PeriodicalIF":0.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}