Use of Integrated Fixation for the Treatment of Traumatic Tibial Bone Defects: A Systematic Review

Integrated fixation is an emerging technique for the treatment of posttraumatic tibial bone defects that reduces external frame duration by combining external fixation with internal fixation to minimize complications. This systematic review focuses on integrated fixation strategies and assesses outcomes when managing posttraumatic tibial bone defects.

A systematic review following PRISMA guidelines was conducted across MEDLINE®, EMBASE®, and PubMed®. Studies published between 1975 and 2025 reporting integrated fixation techniques in skeletally mature patients with posttraumatic tibial defects were included. Outcomes assessed included union rates, complications, external fixation duration, Association for the Study and Application of Methods of Ilizarov (ASAMI) function and bone scores, and pain.

Following identification of 699 studies and removal of 86 duplicates, 38 articles underwent full-text screening. Six studies, including 64 patients (mean age 41.2 years), met inclusion criteria. Integrated fixation demonstrated a combined union rate of 97%, with an average external fixation duration of 151.3 days and a mean union time of 6.6 months. Complications included pin-tract infections (44%), equinus contractures (10%), and refractures (4.7%). ASAMI scores were excellent in 74% of evaluated patients for functional outcomes and 91% for bone outcomes, with minimal or absent pain in 100% of cases.

Integrated fixation demonstrated favorable outcomes in managing posttraumatic tibial bone defects. This approach offers a promising alternative to conventional methods, by reducing complications resulting from prolonged external fixation.

The online version contains supplementary material available at 10.1007/s43465-025-01537-9.