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Surgical treatment of critical size bone defects with Masquelet technique versus bone transport: a systematic review and meta-analysis of comparative studies

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

To date, the management of critical-sized bone defects lacks a universally accepted approach among orthopedic surgeons. Currently, the main options to treat severe bone loss include autologous grafting, free vascularized bone transfer, bone transport and induced-membrane technique. The purpose of this study is to critically compare the outcomes of Masquelet technique and bone transport to provide a higher level of evidence regarding the indexed techniques.

Material and methods

The authors conducted a systematic search on several databases according to the PRISMA guidelines. English-written reports comparing outcomes of the Masquelet technique versus the bone transport technique in patients with critical-sized defects in lower extremities were included.

Results

Six observational studies involving 364 patients were included. The systematic review and meta-analysis of pooled data showed no significant difference in most outcomes, except for ASAMI bone outcomes and residual deformity, which showed better results in the bone transport group. The 64% of patients treated with Masquelet technique obtained excellent/good bone ASAMI results compared to 82.8% with bone transport (p = 0.01). Post-operative residual deformity was 1.9% with the bone transport method versus 9.7% with the Masquelet technique (p = 0.02).

Conclusions

Both the Masquelet technique and bone transport showed comparable results for the management of critical-sized bone defects of the lower limb. However, these findings must be carefully interpreted due to the high risk of bias. Further prospective randomized controlled trials are necessary to better clarify the strengths and limitations of these two techniques and to identify the variables affecting the outcomes.

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Data availability

All data supporting the findings of this study are available within the paper and its Supplementary Information.

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Author notes

  1. Lucrezia Allesina and Mattia Alessio-Mazzola co-first authorship, the authors equally contributed to this research.

  2. Giacomo Placella and Vincenzo Salini co-last authorship, the authors equally contributed to this research.

Authors and Affiliations

  1. Università Vita-Salute San Raffaele, Milan, Italy

    Lucrezia Allesina, Salvatore Mosca, Giacomo Placella & Vincenzo Salini

  2. Orthopaedic and Trauma Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy

    Mattia Alessio-Mazzola

  3. Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Viale Vincenzo Randi, 5, 48121, Ravenna, Italy

    Alberto Belluati

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  1. Lucrezia Allesina
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Correspondence to Mattia Alessio-Mazzola.

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Allesina, L., Alessio-Mazzola, M., Belluati, A. et al. Surgical treatment of critical size bone defects with Masquelet technique versus bone transport: a systematic review and meta-analysis of comparative studies. Arch Orthop Trauma Surg 143, 7081–7096 (2023). https://doi.org/10.1007/s00402-023-05049-9

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