Tibial bone transport using external fixation in adults: a systematic review.

INTRODUCTION: Tibial bone transport using external fixation is widely employed for the reconstruction of large and complex tibial bone defects; however, indications and surgical strategies remain highly heterogeneous. Tibial bone transport using external fixation is a demanding but reliable reconstructive technique, characterized by low failure rates and generally favorable outcomes despite frequent complications. Adequate soft-tissue management, selective docking-site grafting, and early functional rehabilitation were commonly reported. Further prospective studies are needed to standardize treatment strategies and improve clinical decision-making. MATERIALS AND METHODS: A systematic review was conducted in accordance with PRISMA guidelines in April 2025, searching PubMed/MEDLINE and the Cochrane Library. Extracted data included patient demographics, comorbidities, indications, defect length, surgical technique, frame type, external fixation time, healing index, complications, failures, and ASAMI bone and functional outcomes. Methodological quality was assessed using the MINORS score and results were synthesized descriptively. RESULTS: A total of 3543 patients from 89 studies were included. Post-traumatic infection or osteomyelitis accounted for 58.5% of indications. The mean defect length was 7.04 cm. Bifocal bone transport was performed in 82.4% of cases, and circular external fixation was used in 79.0%. Early weight-bearing was allowed in approximately 95% of patients. The mean external fixation time was 11.0 months, with a healing index of 54.2 days/cm. The overall failure rate was 25/2748 (0.9%). Most studies were Level III-IV and were of fair-to-good methodological quality. CONCLUSION: Tibial bone transport using external fixation is a demanding but reliable reconstructive technique, characterized by low failure rates andgenerally favorable outcomes despite frequent complications. Adequate soft-tissue management, selective docking-site grafting, and early functional rehabilitation were commonlyreported. Further prospective studies are needed to standardize treatment strategies and improve clinical decision-making. LEVEL OF EVIDENCE: III-IV.