Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis.
This meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques.



The PubMed and the Cochrane Library databases were searched using the terms: 'fracture' AND ('bone loss' OR 'defect' OR 'defects') AND 'bone graft', restricted to English language, to human species, and to a publication period from January 1999 to November 2014. Data were extracted by one of the reviewers and then checked by the second. A quality of evidence score and a methodology score were used. Heterogeneity was assessed. A random effects model approach was used to combine estimates.



Out of 376 selected studies only 34 met the inclusion criteria. The summary pooled union rate was 91 % (95 % CI: 87-95 %) while union rate after additional procedures raised to 98 % (95 % CI 96-99 %). No association between union rate and bone defect size was found. (Univariable regression model: vascularized: P = 0.677; non-vascularized: 0.202. Multivariable regression model: vascularized: P = 0.381; non-vascularized: P = 0.226). Vascularized graft was associated with a lower risk of infection after surgery when compared to non-vascularized graft (95 % CI 0.03 to 0.23, p < 0.001).



The results of this meta-analysis demonstrate the effectiveness of autologous graft for bone defects. Furthermore, from the available clinical evidence bone defect size does not seem to have an impact on bone union when treated with autologous bone graft techniques.
Manoel Victorino Hospital, Conselheiro Almeida Couto square S/N, 40050-410, Salvador, Bahia, Brazil. mlazi@hotmail.com.
Matheus Lemos
0000-0002-4456-6423
ML
Azi
Department of Orthopaedic Surgery, San Luigi Hospital of Orbassano, University of Turin, Regione Gonzole n.10, 10043, Turin, Italy.
Alessandro
A
Aprato
AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600, Dübendorf, Switzerland.
Irene
I
Santi
Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus - Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Av. Bandeirantes 3900, 14048-900, Ribeirão Preto, São Paulo, Brazil.|Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, Missouri, USA.
Mauricio
M
Kfuri
Department of Orthopaedic Surgery, San Luigi Hospital of Orbassano, University of Turin, Regione Gonzole n.10, 10043, Turin, Italy.
Alessandro
A
Masse
AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600, Dübendorf, Switzerland.
Alexander
A
Joeris
D064591:Allografts / Q000098:blood supply / Q000637:transplantation*; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D005599:Fractures, Ununited / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
Bone graft; Bone reconstruction; Large bone defects; Segmental bone defect