SLR - August 2023 - Yona Mizrahi, DPM
Title: Comparison of the clinical outcomes between vascularized bone graft and the Masquelet technique for the reconstruction of Gustilo type III open tibial fracturesReference: Lan, Ching-Yu et al. “Comparison of the clinical outcomes between vascularized bone graft and the Masquelet technique for the reconstruction of Gustilo type III open tibial fractures.” BMC musculoskeletal disorders vol. 23,1 1036. 1 Dec. 2022, doi:10.1186/s12891-022-06010-4
Level of Evidence: III
Scientific Literature Review
Reviewed By: Yona Mizrahi, DPM
Residency Program: MedStar Health - Washington Hospital Center
Podiatric Relevance: Treating segmental bone defects after incidents of trauma, nonunion, infection, etc has been a difficult task for practitioners over the years. Common approach to treating this issue has been the use of vascularized bone graft, and most recently the concept of the Masquelet technique. Both approaches have shown success, but in this novel study the researchers compare the efficacies and differences between both approaches in treating Gustilo type III open tibial fractures. The goal of reviewing this research paper is to help podiatric practitioners give insight on what approach could help them obtain better outcomes when dealing with such issues.
Methods: A total of 44 patients were retrospectively reviewed with type III traumatic open tibial fractures. 27 patients underwent vascularized bone graft (VBG) and 17 underwent masquelet technique (MT). For VBG transfer, a single stage reconstruction was performed unless there was extensive lesion and infection. For MT protocol, 2 stage reconstruction was performed. Clinical outcomes that were analyzed were union status, time to union, postoperative infection, and reasons for union failure. Kaplan–Meier method was used for analysis of defect length and union time, chi-square test or Fischer’s exact test used for categorical variable association, independent t-test or Wilcoxon rank-sum test used for means of continuous variables, and Mann–Whitney U test for medians of continuous variables.
Results: There were no significant differences between union time in the VBG groups vs MT group (20.5 ± 15.4 months vs 15.1 ± 9.0). The union time for defects less than 60 mm was longer for the VBG versus MT groups (17.2 ± 5.6 months versus 10.7 ± 4.7 months, p = 0.067). However, the union time for defects greater than 60 mm was shorter in the VBG group than in the MT group (21.0 ± 17.0 months versus 23.8 ± 9.4 months, p = 0.729). Post-operative infection was higher in the VBG vs MT group (70.4% vs 47.1%, p= 0.122). Osteomyelitis developed in 12 (44.4%) out of the 27 VBG patients and 6 (35.3%) out of the 17 MT patients.
Conclusions: The study concluded that there is no statical difference between the VBG and MT group regarding union time, total treatment time, post-operative infection or consequential osteomyelitis. Limitations of the study include the fact it was non-randomized, has a small sample size and possible bias in surgical protocol. Due to these limitations, additional higher level of evidence studies are required. Overall, the study provides practitioners a better understanding of various treatment plans for treating these unpredictable traumatic cases.