Comparative Outcomes of Bone Shortening versus Bone Transport in the Management of Bone Defects: A Literature Review

Segmental bone defects, particularly in weight-bearing bones such as the tibia and femur, present significant challenges in reconstructive orthopaedics. These defects can result from trauma, infections, tumor resections, or non-unions after failed surgeries. Bone grafting is often inadequate for large defects, leading to the adoption of distraction osteogenesis (DO) techniques, specifically acute shortening with subsequent re-lengthening (ASR) and bone transport (BT). This literature review compares the outcomes of ASR and BT in managing bone defects, focusing on treatment duration, complication rates, and functional outcomes. ASR involves shortening the bone to close the defect, followed by gradual re-lengthening through the process of distraction osteogenesis. In contrast, BT preserves limb length by gradually transporting a bone segment across the defect. Both methods aim to achieve bone union, restore function, and eradicate infection, but their complication profiles differ. ASR offers shorter treatment times, fewer surgeries, and a reduced external fixation index, but it is limited to smaller defects. BT, suitable for larger defects, preserves limb length but requires longer external fixation and may result in higher rates of docking-site complications. Hybrid approaches combining both techniques are increasingly utilized, allowing for infection control and soft-tissue closure with ASR followed by BT or re-lengthening. Ultimately, treatment selection should be tailored to the defect's size, location, vascular condition, and soft-tissue status. Evidence supports ASR for smaller defects and modern BT modifications for larger or more complex cases. Keywords: acute shortening, bone transport, ilizarov technique