Modern technologies for replacing bone tissue defects (bone transport, Masquelet): literature review and meta-analysis

Background. Bone defects are a pathological condition characterized by a loss of bone tissue volume that cannot be restored independently even with adequate measures and surgical stabilization. In the literature, this condition is described as a critical defect: length over 2 cm and bone mass loss over 50 %. Bone defects are divided into primary or secondary ones and are the result of a fairly wide range of factors: tumors of the musculoskeletal system, infections, high-energy injuries, osteofibrous dysplasias, or congenital defects (Adams-Oliver syndrome). With the beginning of full-scale aggression, combat injuries (fire and mine-explosive), which arise as a result of high-energy combined effects and lead to polystructural damage, became the main factor in both primary and secondary bone defects. Objective: to compare the clinical outcomes of using the Masquelet technique and bone transport in the treatment of patients with segmental defects of the long bones of the extremities. Materials and methods. In two databases (PubMed, Embase), the current literature was analyzed on the treatment of defects of long tubular bones from 2016 to 2025 with the help of the Ilizarov method (bone transport) and Masquelet technique (induced membrane) using the keywords: bone defect, nonunion, bone transport, Masquelet method, complications. Results. The most common disadvantages and complications of bone transport are long-term use of the external fixation device, infection of the pin site (65.96 %), axial deviation (40.78 %), joint stiffness (23.76 %), soft tissue compression (22.34 %), and delayed fusion of the junction (13.48 %). To reduce their number, various improvements have been proposed. In particular, the trifocal method, the use of unilateral external devices with intramedullary fixators, intramedullary cable transport, and bone transport using magnetic intramedullary rods are gaining popularity. Positive results when using the Masquelet method are about 86 versus 95 % with bone transport, but it demonstrates advantages in lower hospitalization costs, shorter time from final union to full load, lower complication rates, and better post-operative quality of life. Conclusions. Bone transport and Masquelet method are the most widely used modern techniques in the treatment of patients with bone defects. Positive results with the use of these techniques are about 86–95 %, which is quite significant considering polystructural lesions. Each method is characterized by advantages and disadvantages, which are determined by the specifics of its implementation and the severity of the injury, which requires the use according to clearly defined indications.