Treatment of Post-traumatic Tibial Diaphyseal Bone Defects: Systematic Review and Meta-Analysis

Objective To describe evidenced-based treatment options for patients who sustained trauma and/or post-traumatic osteomyelitis of the tibia resulting in diaphyseal bone defects and compare outcomes between patients treated with non-vascularized bone grafts (NBG), bone transport (BT), or vascularized bone grafts (VBG). Data source PRISMA-IPD and Cochrane guidelines were followed. PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL were searched June 2020. Study selection Eligible patients were >=18 years of age, sustained trauma to the tibia resulting in fracture and/or osteomyelitis with measurable diaphyseal bone defects, treated by interventions NBG, BT, or VBG. Excluded studies were non-English, reviews, non-reviewed literature, cadavers, animals, unavailable full-texts, non-diaphyseal defects, atrophic nonunions, malignancy, and replantations. Data extraction One hundred and eight studies included 826 patients. Two reviewers systematically/independently screened titles/abstracts, followed by full-texts to ensure quality, accuracy and consensus amongst authors for inclusion/exclusion of studies. A third reviewer addressed disagreements if investigators were unable to reach a consensus. Studies were quality assessed with "Methodological Quality and Synthesis of Case Series and Case Reports System." Data synthesis Analyses were performed with IBM SPSS Version 25.0 (IBM Corporation, Armonk, New York) and G*Power3.1.9.2. Conclusions NBG may be considered first-line for trauma defect sizes =5cm. Level of evidence Therapeutic Level IV.