PURPOSE: The aim of this study was to compare the efficacy, clinical outcomes, and complications of cable-asisted bone transport (CASt) and circular external fixator-assisted bone transport (CEFt) methods in the management of bone defects of the tibia. METHODS: A retrospective analysis was conducted on 32 patients who underwent segmental bone transport for tibial bone defects between January 2006 and January 2020 and met the study inclusion criteria. Patients were categorized into two groups: CASt group (n = 16) and CEFt group (n = 16). The primary outcome measures included radiological parameters (External Fixator Index (EFI), Radiological Consolidation Time (RCT), and Radiological Consolidation Index (RCI)), functional independence (Lower Extremity Functional Index, LEFI) and functional outcomes (ASAMI Bone and Functional Scores). Secondary outcomes included pain levels (Visual Analog Scale, VAS), and complication rates (Paley's and Checketts-Otterburn classifications). RESULTS: The CASt method resulted in significantly reduced pain scores during distraction (VAS: 4.81 ± 0.98 vs. 6.75 ± 0.86
p = 0.001). Pin-tract infection rates were significantly lower in the CASt group compared to the CEFt group (50% vs. 93.8%
p = 0.013). There was no significant difference between the groups in radiological (EFI, RCT, RCI) and functional outcomes (ASAMI scores) (p >
0.05). CONCLUSION: Both CASt and CEFt methods are effective and reliable options in the management of bone defects of the tibia. However, CASt offers advantages such as lower pin-tract infection rates and less pain during distraction, resulting in greater patient comfort and compliance. Given its less invasive nature, CASt may be preferable in patients at higher risk of infection or with a low pain threshold. However, the technical complexity of this method requires experienced surgical application.