Management of post-traumatic long bone defects: A comparative study based on long-term results

Area of Science:

• Orthopedic surgery
• Regenerative medicine
• Trauma reconstruction

Background:

• Post-traumatic long bone defects present significant reconstruction challenges.
• Current surgical approaches for bony reconstruction remain a subject of debate.
• Evaluating long-term functional and self-reported outcomes is crucial for treatment comparison.

Purpose of the Study:

• To compare the efficacy of three surgical methods for reconstructing post-traumatic long bone defects.
• To assess long-term functional results and patient self-evaluation based on complication rates, treatment duration, and quality of life scores.
• To provide evidence-based guidance for the treatment of complex long bone defects.

Main Methods:

• Retrospective review of 317 patients with lower extremity long bone defects (January 2006 - January 2015).
• Patients were stratified into three groups: free vascularized fibular transfer, distraction osteogenesis, and induced membrane technique.
• Data collected included complication rates, treatment duration (surgery to non-protected weight-bearing), Visual Analog Scale (VAS), and Sickness Impact Profile (SIP) scores.

Main Results:

• Major complication rates were similar across the three groups (22.6% vs. 25.8% vs. 26.6%, P > 0.05).
• Mean treatment durations varied: distraction osteogenesis (46.5 weeks) was shorter than induced membrane technique (56.6 weeks) and free vascularized fibular transfer (65.1 weeks).
• At 2 years postoperatively, Sickness Impact Profile (SIP) scores were comparable across groups (10.5 vs. 11.7 vs. 11.5, P > 0.05).

Conclusions:

• Free vascularized fibular transfer, distraction osteogenesis, and the induced membrane technique yield comparable long-term outcomes for post-traumatic long bone defects.
• The choice of surgical method can be guided by factors such as desired treatment duration, as distraction osteogenesis showed a shorter overall treatment period.
• These findings support the use of any of these three techniques for effective long-term reconstruction of long bone defects.