Bone transport in the management of fracture-related infection: current concepts and innovations

Abstract. Despite advances in musculoskeletal trauma care, segmental bone loss remains a major clinical challenge. A substantial proportion of these cases are associated with fracture-related infection (FRI), which fundamentally alters the biological environment and reconstructive strategy. In this context, FRI should be considered in any patient with a segmental bone defect, and thorough surgical debridement with acquisition of multiple deep-tissue cultures represents an essential first step in management. The presence of infection reduces the likelihood of bone consolidation and eradication of disease, emphasizing the need for strict adherence to established FRI treatment principles. Depending on the extent of bone loss, host factors, and available expertise, patients may be eligible for a range of reconstructive options. Bone transport is one of these surgical methods and involves the gradual translocation of bone segments to reconstruct defects in long bones. Based on the principles of distraction osteogenesis (DO), controlled mechanical distraction promotes predictable bone regeneration according to Ilizarov's principles. Traditionally, DO has relied on circular external fixators. Recent developments involving integrated fixation, such as bone transport over a nail, have reduced morbidity and enabled faster reconstruction. Although these techniques carry a risk of contaminating the intramedullary canal, exclusive long-term use of external fixators is not harmless. Further innovations, such as motorized telescopic intramedullary nails, have led to the gradual replacement of external fixation, making the procedure less burdensome for patients. Advances in surgical skills and technology have enabled the treatment of more complex cases, making a specialized, multidisciplinary approach essential in modern clinical care.