Hybrid Bone Transport for Large Bone Defects of the Lower Limb: A Retrospective Cohort Study of Early Clinical Outcomes From a Single Center

Background Large bone defects of the lower limb remain a reconstructive challenge. Traditional Ilizarov bone transport is effective but associated with prolonged external fixation. Hybrid techniques combining internal and external fixation have been utilized to reduce the external fixation index (EFI). This study evaluates clinical, radiological, and functional outcomes of hybrid bone transport techniques. Methods A retrospective cohort study was conducted at a tertiary trauma center between April 2022 and March 2026. Patients with post-traumatic lower limb bone defects treated with hybrid bone transport techniques were included. The primary outcome was the EFI. Secondary outcomes included time to union, complications, and bone functional outcomes assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Results Six patients (mean age = 32.2 years) with a mean defect size of 10.3 ± 3.6 cm were included. The mean time to union was 8.3 ± 1.8 months. The mean time on frame was 99.8 ± 30.3 days. The mean EFI was 14 ± 3.2 days/cm. All patients achieved union. Complications included malalignment requiring revision (n = 1) and joint stiffness (n = 2). The ASAMI bone and functional outcomes were good and excellent. Conclusion Hybrid bone transport techniques substantially reduce EFI compared to traditional Ilizarov methods while maintaining high union rates and favorable functional outcomes.