Treatment of Traumatic Segmental Long-Bone Defects A Critical Analysis Review

Segmental long-bone defects are rare injuries, making study of their treatment and outcomes difficult. The true critical-sized defect (defined as a defect that will not heal during the lifetime of the animal or patient) is unknown, and translation of animal models and studies to clinical practice remains challenging because of the limitations associated with each model. There is a lack of optimally designed clinical trials evaluating different aspects of segmental bone defects after traumatic injury. Free vascularized fibular grafting procedures are technically demanding and are associated with a lower union rate when compared with other treatment alternatives. The induced membrane technique takes advantage of the creation of a vascularized envelope with osteogenic factors that can improve union rates when staged bone-grafting is performed. Bone transportation has proved to be a reliable option for the treatment of segmental defects; however, patient comfort, the difficult initial learning process associated with the technique, and the demands of postoperative frame management have likely contributed to its limited use.