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 <=10cm, or post-traumatic osteomyelitis defect sizes <5cm. BT may be considered first-line for post-traumatic osteomyelitis defect sizes <5cm. VBG may be considered first-line for trauma and post-traumatic osteomyelitis defect sizes >=5cm.

Level of evidence: Therapeutic Level IV.