Clinical Practice Guideline of Surgical Treatment of Segmental Bone Defects After Open Tibia Diaphyseal Fracture

Purpose: Segmental tibial diaphyseal bone defects after open fracture are difficult to treat and require timely, coordinated reconstruction. We aimed to develop evidence-based surgical guidelines based on meta-analysis and consensus recommendations from an expert committee of orthopedic surgeons. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, we searched 5 databases (1989 to 2024) for studies evaluating surgical treatment of post-traumatic tibial diaphyseal segmental defects. Random-effects models pooled union rate, union time, and complication rate across 4 techniques (Ilizarov bone transport [IBT], free vascularized bone grafting [FVBG], nonvascularized autografting [AG], and the Masquelet technique [MT]). Consensus recommendations were developed using a Delphi process. Results: Twenty-eight studies, including 824 patients (824 tibias) were analyzed: IBT (11 studies; n=361), FVBG (4; n=68), AG (10; n=164), and MT (6; n=67). Pooled union rates were 96% (IBT), 95% (FVBG), 95% (AG), and 81% (MT). Mean pooled union times were 33.04 weeks (IBT), 37.81 (FVBG), 29.73 (AG), and 29.74 (MT). Pooled complication rates were 82% (IBT), 94% (FVBG), 44% (AG), and 53% (MT). Conclusion: On the basis of the evidence and expert consensus, early operative management with prompt stabilization and antimicrobial therapy, supported by multidisciplinary care, is recommended. For large or complex defects, IBT and FVBG are generally preferred, while AG and MT remain options in selected scenarios. Outcomes depend on early intervention, appropriate technique selection, and structured rehabilitation; further high-quality studies are needed to validate these recommendations.