A Comparative Study of Doppler‐Guided Acute Bone Shortening‐Lengthening Versus Bone Transport for Infected Tibial Defects Combined With Soft Tissue Defects

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OBJECTIVE: The management of infected tibial bone defects with soft tissue defects (ITBD-STD) remains challenging. This study aims to establish a Doppler-guided safety threshold for acute shortening (≤ 3 cm), compare the clinical efficacy and safety of shortening-lengthening (S-L) versus bone transport (BT), quantify the complication burden, and clarify the calculation indices. METHODS: test. RESULTS: The WHT in the S-L group was significantly shorter than that in the BT group (68.5 ± 25.2 vs. 85.2 ± 21.5 days, p < 0.05). In the S-L group, acute shortening was successfully performed in all 22 patients under real-time Doppler guidance, with a mean acute shortening distance of 2.8 ± 0.4 cm (capped at 3 cm). No patient experienced Doppler signal loss or required intraoperative termination of shortening due to vascular compromise. The BHI (37.36 ± 10.73 vs. 44.14 ± 11.12 days/cm) and EFI (45.36 ± 11.23 vs. 53.52 ± 12.55 days/cm) in the S-L group were significantly lower than those in the BT group (all p < 0.05). However, there was no statistically significant difference in the overall complication rate between the two groups (45.5% vs. 42.9%, p > 0.05). At the final follow-up, there was also no statistically significant difference in ASAMI scores between the two groups (p > 0.05). CONCLUSION: Both S-L and BT are effective for ITBD-STD with comparable safety. Under the strict Doppler-guided protocol (≤ 3 cm), S-L significantly shortens WHT without increasing complications, yet this benefit is design-inherent rather than a biological advantage. Given comparable ASAMI functional outcomes, S-L offers no functional superiority over BT. Nonetheless, the Doppler criteria and selection strategy established herein provide a safe, reproducible framework for technique selection, validating the clinical feasibility of acute shortening without compromising final function or safety.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.