Treatment Options for Nonunion With Segmental Bone Defects: Systematic Review and Quantitative Evidence Synthesis.
OBJECTIVE
To determine which reconstruction treatment of long bones nonunion with segmental bone defects (SBDs) is effective to restore bone length and union with good function.


METHODS
PubMed was used to identify published literature on treatment of SBD caused by fracture nonunion regardless of infection between January 1975 and December 2014.


METHODS
We included retrospective cohort studies with a minimum sample size of 10 consecutive patients with minimum follow-up of 18 months and available data on radiographic and functional outcomes.


METHODS
Literature review revealed 24 publications with a sample size of 504 patients (395 males, 109 females). Data on bone union and functional outcome and complications were collected and analyzed based on validated classification systems.


RESULTS
Two outcome groups were categorized for bone union and functional outcome, success, and failure. We then performed heterogeneity test to examine the variability or differences in the methods used by these studies and based on that we determined whether the fixed effect or random effect method is appropriate in examining the summary or pool estimate. Pool estimate was examined for bone union and functional outcome in each surgical modality and in each anatomic location when data were available.


CONCLUSIONS
Treatment of SBD can be challenging. This quantitative evidence synthesis shows that bone union was achieved by different procedures with variable bone union and functional outcomes.


METHODS
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
*International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; and †Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Muayad
M
Kadhim
Larry
L
Holmes
Martin G
MG
Gesheff
Janet D
JD
Conway
D000293:Adolescent; D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D005592:Fracture Fixation / Q000706:statistics & numerical data*; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult