1. The management of critical bone defects: outcomes of a systematic approach.
- Author
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Tsang, Shao-Ting Jerry, van Rensburg, Adrian Jansen, van Heerden, Jason, Epstein, Gadi Zwe, Venter, Rudolph, and Ferreira, Nando
- Subjects
FRACTURE healing ,RISK assessment ,FRACTURE fixation ,TIBIAL fractures ,COMPOUND fractures ,TREATMENT effectiveness ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,LONGITUDINAL method ,ORTHOPEDIC surgery ,BONE grafting ,SEPSIS ,CONFIDENCE intervals ,PLASTIC surgery ,ALGORITHMS ,DISEASE risk factors - Abstract
Background: The reconstruction of segmental long bone defects remains one of 'The holy grails of orthopaedics'. The optimal treatment of which remains a topic of great debate. This study aimed to evaluate the outcomes following the management of critical-sized bone defects using a classification-based treatment algorithm. Methods: A retrospective review of all patients undergoing treatment for segmental diaphyseal defects of long bones at a tertiary-level limb reconstruction unit between January 2016 and December 2021, was performed. The management of the bone defect was standardised as per the classification by Ferreira and Tanwar (2020). Results: A total of 96 patients (mean age 39.8, SD 15.2) with a minimum six months follow-up were included. Most bone defects were the result of open fractures (75/96) with 67% associated with Gustilo-Anderson IIIB injuries. There was a statistical difference in the likelihood of union between treatment strategies with more than 90% of cases undergoing acute shortening and bone transport achieving union and only 72% of cases undergoing the induced membrane technique consolidating (p = 0.049). Of those defects that consolidated, there was no difference in the time to bone union between strategies (p = 0.308) with an overall median time to union 8.33 months (95% CI 7.4 – 9.2 months). The induced membrane technique was associated with a 40% risk of sepsis. Conclusion: This study reported the outcomes of a standardised approach to the management of critical-sized bone defects. Whilst overall results were supportive of this approach, the outcomes associated with the induced membrane technique require further refinement of its indications in the management of critical-sized bone defects. Level of evidence: 4. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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