Trifocal Ilizarov Bone Transport for a 21-cm Tibial Defect in a Chronic Smoker with Longstanding Osteomyelitis: A Complex Limb Salvage Case

This case study presents the successful management of a 21-cm tibial defect in a 38-year-old man smoker with longstanding osteomyelitis using trifocal Ilizarov bone transport. Despite the complexities posed by chronic infection and extensive bone loss, a meticulously planned staged reconstructive protocol involving aggressive debridement, targeted antimicrobial therapy, and advanced bone transport techniques culminated in remarkable limb salvage and functional recovery. Integration of low-intensity pulsed ultrasound (LIPUS) further optimized bone healing in this intricate scenario. This case report addresses these gaps by detailing a successful trifocal Ilizarov strategy augmented with LIPUS in a chronic smoker with an exceptionally large tibial defect.