This study presents a novel surgical strategy for the management of severe post-traumatic tibial bone defects through a sequential combination of two limb-lengthening techniques.

The case involved a 29-year-old patient with a 16 cm tibial bone defect, initially treated with an external fixator to achieve 10 cm of bone transport through distraction osteogenesis. In a second stage, the external fixator was replaced with a motorized intramedullary lengthening nail, allowing an additional 6 cm of bone lengthening.

The innovative aspect of this study lies in its fully staged approach. According to the authors’ literature review, no previous studies have clearly described a completely sequential technique in which external fixation is used during the first phase and subsequently converted to a motorized internal lengthening system to complete the reconstruction.

This approach may offer several clinical advantages, including reduced external fixation time, improved patient comfort, enhanced mechanical stability, and better protection of neurovascular structures.

The study suggests that sequential conversion from external fixation to a motorized intramedullary nail could represent a promising new option for the treatment of large tibial bone defects, while highlighting the need for further research to evaluate long-term outcomes and reproducibility.