{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:53:19Z","timestamp":1790913199353,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100006606","name":"Natural Science Foundation of Tianjin Municipality","doi-asserted-by":"publisher","award":["24JCYBJC01440"],"award-info":[{"award-number":["24JCYBJC01440"]}],"id":[{"id":"10.13039\/501100006606","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The management of infected tibial bone defects with soft tissue defects (ITBD\u2010STD) remains challenging. This study aims to establish a Doppler\u2010guided safety threshold for acute shortening (\u2264\u20093\u2009cm), compare the clinical efficacy and safety of shortening\u2010lengthening (S\u2010L) versus bone transport (BT), quantify the complication burden, and clarify the calculation indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective analysis was conducted on the clinical data of 43 patients with ITBD\u2010STD admitted between January 2021 and January 2024. All patients were treated using the Ilizarov circular external fixation technique and were divided into a bone S\u2010L group and a BT group based on the surgical procedure. In the S\u2010L group, acute shortening was performed under real\u2010time Doppler guidance with a predefined safety cap of 3\u2009cm. The wound healing time (WHT), bone healing index (BHI), external fixation index (EFI), and complication rate were compared and analyzed between the two groups. At a mean follow\u2010up of 19.9\u2009months, bone union and lower limb functional recovery were evaluated using the criteria of the Association for the Study and Application of the Ilizarov Method (ASAMI). Statistical analysis was performed using the independent sample\n                      <jats:italic>t<\/jats:italic>\n                      \u2010test or the\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The WHT in the S\u2010L group was significantly shorter than that in the BT group (68.5\u2009\u00b1\u200925.2 vs. 85.2\u2009\u00b1\u200921.5\u2009days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). In the S\u2010L group, acute shortening was successfully performed in all 22 patients under real\u2010time Doppler guidance, with a mean acute shortening distance of 2.8\u2009\u00b1\u20090.4\u2009cm (capped at 3\u2009cm). No patient experienced Doppler signal loss or required intraoperative termination of shortening due to vascular compromise. The BHI (37.36\u2009\u00b1\u200910.73 vs. 44.14\u2009\u00b1\u200911.12\u2009days\/cm) and EFI (45.36\u2009\u00b1\u200911.23 vs. 53.52\u2009\u00b1\u200912.55\u2009days\/cm) in the S\u2010L group were significantly lower than those in the BT group (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). However, there was no statistically significant difference in the overall complication rate between the two groups (45.5% vs. 42.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). At the final follow\u2010up, there was also no statistically significant difference in ASAMI scores between the two groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both S\u2010L and BT are effective for ITBD\u2010STD with comparable safety. Under the strict Doppler\u2010guided protocol (\u2264\u20093\u2009cm), S\u2010L significantly shortens WHT without increasing complications, yet this benefit is design\u2010inherent rather than a biological advantage. Given comparable ASAMI functional outcomes, S\u2010L 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70409","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T23:35:07Z","timestamp":1787787307000},"page":"2128-2141","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Comparative Study of Doppler\u2010Guided Acute Bone Shortening\u2010Lengthening Versus Bone Transport for Infected Tibial Defects Combined With Soft Tissue Defects"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1002-1254","authenticated-orcid":false,"given":"Zhiming","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Traumatic Orthopaedics, Tianjin Hospital Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqi","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Traumatic Orthopaedics, Tianjin Hospital Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengkuo","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Traumatic Orthopaedics, Tianjin Hospital Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiguo","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Traumatic Orthopaedics, Tianjin Hospital Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010024\u201008248\u20106"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.70067"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000002953"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010025\u201008454\u2010w"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000003072"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620x.107b12.Bjj\u20102024\u20100882.R2"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9020279"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.2095\u20104344.2015.20.021"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010024\u201007507\u2010w"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010023\u201006955\u20100"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2025.112372"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2023.01.029"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018\u2010022\u201003109\u20101"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199001000\u201000011"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/2716547"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.5704\/moj.2507.012"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018\u2010025\u201005648\u20109"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010022\u201020760\u20100"},{"issue":"1","key":"e_1_2_13_20_1","first-page":"91","article-title":"Acute Shortening and re\u2010Lengthening in the Management of Open Tibia Fractures With Severe Bone of 14 CMS or More and Extensive Soft Tissue Loss","volume":"108","author":"Zierenberg Garc\u00eda C.","year":"2016","journal-title":"Bolet\u00edn de la Asociaci\u00f3n M\u00e9dica de Puerto Rico"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018\u2010023\u201004356\u20106"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018\u2010023\u201003783\u20109"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010024\u201007603\u2010x"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010022\u201005078\u20102"}],"container-title":["Orthopaedic 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