Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature

Abstract

Large bone defects resulting from musculoskeletal tumours, infections, or trauma are often unable to heal spontaneously. The challenge for surgeons is to avoid amputation, and provide the best functional outcomes. Allograft, vascularized fibular or iliac graft, hybrid graft, extracorporeal devitalized autograft, distraction osteogenesis, induced-membrane technique, and segmental prostheses are the most common surgical strategies to manage large bone defects. Given its optimal osteogenesis, osteoinduction, osteoconduction, and histocompatibility properties, along with the lower the risk of immunological rejection, autologous graft represents the most common used strategy for reconstruction of bone defects. However, the choice of the best surgical technique is still debated, and no consensus has been reached. The present study investigated the current reconstructive strategies for large bone defect after trauma, infections, or tumour excision, discussed advantages and disadvantages of each technique, debated available techniques and materials, and evaluated complications and new perspectives.

Mechanical Distribution and New Bone Regeneration After Implanting 3D Printed Prostheses for Repairing Metaphyseal Bone Defects: A Finite Element Analysis and Prospective Clinical Study

“…Metaphyseal bone defects of extremities can be caused by severe trauma, osteomyelitis, tumor and revision surgery (Mancuso et al, 2017;Lu et al, 2019;Benulic et al, 2020). Traditional therapeutic methods such as bone grafting, distraction osteogenesis, and induced-membrane technique cannot accomplish simultaneous reconstruction of both complete anatomical structure and stable biomechanical conduction to support early weight-bearing (Migliorini et al, 2021).…”

“…Applying 3D printed titanium alloy prostheses to repair critical metaphyseal bone defects is a feasible treatment option, whose major advantages include: 1) the shape and structure of a prosthesis can be customized based on the irregular defect outline; 2) the appropriate mechanical strength of titanium alloy can rebuild the local biomechanical stability and help patients perform weight-bearing and functional exercise; 3) it can stimulate the bone growth in contact with the prosthesis (Ji et al, 2020;Migliorini et al, 2021;Xu et al, 2021). Tetsworth et al (2017) and Nwankwo et al (2019) successfully applied 3D printed framed-structured scaffolds to reconstruct distal femoral and tibial metaphyseal defects caused by comminuted fractures.…”

Acute shortening and re-lengthening versus antibiotic calcium sulfate-loaded bone transport for the management of large segmental tibial defects after trauma

“…Patients and their families face a great physical and mental burden. The main treatment methods for large segmental bone defects include autologous bone transplantation, Ilizarov technique, Masquelet technique, vascularized fibula transplantation and segmental prostheses [ 1 , 5 , 15 – 18 ]. Among them, Ilizarov technique is one of the most effective methods.…”

Reconstruction of extra-large severe punching hole injury in the palm: A case report

“…In general, however, the use of flow-through type immediate ALT flaps in severe limb trauma with large tissue loss is widely accepted as the gold standard operation due to their ability to improve blood flow to the damaged tissue and fill the large complex tissue defect [8] , [9] . In addition, if the bone defect is extensive, it may be difficult to achieve sufficient stability with a common plate and screw, and various staged treatments are usually required [10] .…”