NAIL- AND CABLE-ASSISTED BONE TRANSPORT: NOVEL APPROACHES

Bone transport over the nail (BTON) using external fixation techniques and bone transport with motorized nails are well-known procedures. An additional advantage can be achieved by using cables to connect bone segments or drive units. Cables can prevent the disadvantages of pins, which are normally used to fix bone segments for transport: the typical cutting effect of pins, which can be very painful and, in the presence of free flaps, can damage the connecting anastomosis or the microarchitecture of the flap. This is even more important when techniques with increased transport speed are used – for example in bisegmental unidirectional transports. Cables can be installed so that the cable exit is statically fixed without the cutting of pins. The cable allows further for a gear-like translation so that the speed at the motor unit and the output speed at the segment can be different. Nails can be used like rails to transport the segments: they stabilize the callus and the segments in line and can shorten the time in the frame. In addition, the cables can be guided by the nail. Novel and customized transport techniques using cable and nails to avoid soft tissue damage or even damage to free flaps Bisegmental unidirectional bone transport of the tibia - transport by cable assisted lengthening nail in the femur with enhanced transport capacity Ulna bisegmental transport nail using cable and external fixation Unbalanced cable transport of the tibia: monosegmental and bisegmental Results Transport capacity of motorized nails can be elevated by cable pulley system Bisegmental bone transport of the ulna can be achieved by one running cable Unbalanced cable transport needs special considerations regarding the monolateral arrangement of the construction. Large bone defects place high demands on the reconstruction process and are associated with a high socioeconomic burden. There is a need to accelerate transport time and increase safety, comfort and compliance for both physician and patient. Nails in combination with cables can be very useful in this regard. Combining nail and cable-assisted transport can increase the versatility of already known transport techniques while improving compliance in segmental bone reconstruction. Cables are less damaging to soft tissue. Further technical developments are needed to improve the techniques and ensure safe treatment.