Immediate global reconstruction and bone transport over nail - a novel technique for post traumatic segmental bone loss of Tibia

Large skeletal defects of femur and tibia present a challenging reconstructive problem. Different methods of managing these defects exist but Ilizarov method of bone transport has been shown to be an exciting new method as it does not involve donor site morbidity. We have done bone transport over an interlocking nail (Bone transport over nail, BTON) using Ilizarov frame in a patient with post traumatic segmental bone loss of tibia.  Fracture union time was 12 months and patient returned to manual labour by 17 months from the time of injury. The bone transport result was excellent and functional result was good at the end of 20 months of follow up. We conclude that distraction osteogenesis using Ilizarov frame over an interlocked nail (BTON) is an effective and reliable method of treating post traumatic segmental defects of tibia with minimal complications related to prolonged use of external fixation. However initial debridement must be radical and soft tissue coverage of exposed bone must be appropriate. Surgeon must be cautious with regard to deep infection.