(A14) Systematic Review and Meta-analysis of Clinical Outcomes of Bone Grafting/Reconstruction Following Segmental Long Bone Defects Treated by Induced Membrane Technique

Publication Number: 297

Background: The induced membrane technique (IMT) (also known as Masquelet technique), a two-stage procedure, has been widely used to treat segmental long bone defects since 2000. The impact of potential risk factors on bone union including defect length has been investigated. Interestingly, three systematic reviews and meta-analyses found no significant association between bone defect length and bone union rate. However, these systematic reviews and meta-analyses did not evaluate the association stratified by larger defect lengths of greater than 10 cm.

Objectives: To systematically evaluate clinical outcomes of bone grafting/reconstruction following segmental long bone defects treated by IMT according to bone defect lengths (≤10, >10-17, >17 cm).

Methods: We performed an electronic literature search in four online databases on original clinical studies published from 2000 to September 2020 using a search strategy that was designed to identify studies of bone grafting/reconstruction for treating long bone defects with IMT. Two researchers independently screened the titles and abstracts of the literature search results for relevance. Two researchers independently assessed full-text eligibility. Three researchers performed double data extraction and study quality assessment. We analyzed the 54 included studies (1,836 individuals) with bone union proportion as primary outcome and average bone defect length categories as exposure, using random-effects models and meta-regression models.

Results: The weighted study average bone defect length was 6.17 cm across studies (minimum: 2.05 cm; maximum: 14 cm), with 4 studies that reported an average bone defect length >10 cm. No study had an average bone defect length of >17 cm. The pooled estimate of bone union percentage was 88% (95% confidence interval [CI]: 83%, 92%) for studies with an average bone defect length of ≤10 cm and 97% (95% CI: 81%, 100%) for studies with an average defect length of >10-17 cm. There was no significant difference in bone union percentage between average bone defect lengths of >10-17 cm and ≤10 cm among patients with segmental long bone defects who underwent the IMT procedure. Results were similar in the stratified analysis by study quality assessment score, bone graft type, and study country region. Higher percentage of tibia defects was significantly associated with lower bone union proportion in multivariable analysis.

Conclusions: Our findings support the use of IMT in treating large segmental long bone defects.