Variability in Posterior Vault Distraction Osteogenesis Protocols and Outcome Reporting: A Systematic Review and Meta-Analysis of Distraction Protocols

Objective This meta-analysis characterized variability in the posterior vault distraction osteogenesis (PVDO) distraction protocol and outcome reporting and explored study-level associations between distraction parameters and postoperative complications. Methods This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant systematic review and meta-analysis included pediatric PVDO studies from PubMed, Ovid MEDLINE, and EMBASE (June 12, 2025). Studies underwent quality assessment and data extraction, with pooled proportions calculated using a random-effects model. Results Eleven studies including 479 patients were analyzed. Median distraction distance and activation phase duration were 26.3 mm and 25.4 days, respectively; median latency and consolidation phase durations were 3.1 and 94.5 days, respectively. The pooled complication rate was 44.3% (95% confidence interval (CI): 31%-57%; I 2 = 86%, p < .0001). Weighted logistic regression showed that a higher mean distraction velocity (MDV) was associated with lower rates of dermatologic complications ( p = .027). Weighted linear regression showed that longer activation phases significantly increased skin complications ( p = .025) and device failures ( p = .040). Distraction distance was not significantly associated with postoperative complications in weighted linear regression modeling. Conclusions This review revealed substantial variation in the distraction protocol and patient outcome reporting. While MDV and distraction distance showed weak or inconsistent associations with complications, activation phase duration showed the most consistent study-level associations with postoperative outcomes. However, divergent trends between models, substantial heterogeneity, and reliance on cohort-level averages limit the ability to establish definitive relationships between distraction parameters and complications; these findings should not be used to guide clinical practice. Future studies reporting patient-level distraction protocols, subsequent protocol modifications, and postoperative outcomes are needed to support more robust risk modeling.