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Current Management of Diaphyseal Long Bone Defects—A Multidisciplinary and International Perspective

The treatment of defects of the long bones remains one of the biggest challenges in trauma and orthopedic surgery. The treatment path is usually very wearing for the patient, the patient’s environment and the treating physician. The clinical or regional circumstances, the defect etiology and the pat...

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Autores principales: Bernd, Rosslenbroich Steffen, Chang-Wug, Oh, Thomas, Kern, John, Mukhopadhaya, Johannes, Raschke Michael, Ulrich, Kneser, Christian, Krettek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573364/
https://www.ncbi.nlm.nih.gov/pubmed/37834927
http://dx.doi.org/10.3390/jcm12196283
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author Bernd, Rosslenbroich Steffen
Chang-Wug, Oh
Thomas, Kern
John, Mukhopadhaya
Johannes, Raschke Michael
Ulrich, Kneser
Christian, Krettek
author_facet Bernd, Rosslenbroich Steffen
Chang-Wug, Oh
Thomas, Kern
John, Mukhopadhaya
Johannes, Raschke Michael
Ulrich, Kneser
Christian, Krettek
author_sort Bernd, Rosslenbroich Steffen
collection PubMed
description The treatment of defects of the long bones remains one of the biggest challenges in trauma and orthopedic surgery. The treatment path is usually very wearing for the patient, the patient’s environment and the treating physician. The clinical or regional circumstances, the defect etiology and the patient´s condition and mental status define the treatment path chosen by the treating surgeon. Depending on the patient´s demands, the bony reconstruction has to be taken into consideration at a defect size of 2–3 cm, especially in the lower limbs. Below this defect size, acute shortening or bone grafting is usually preferred. A thorough assessment of the patient´s condition including comorbidities in a multidisciplinary manner and her or his personal demands must be taken into consideration. Several techniques are available to restore continuity of the long bone. In general, these techniques can be divided into repair techniques and reconstructive techniques. The aim of the repair techniques is anatomical restoration of the bone with differentiation of the cortex and marrow. Currently, classic, hybrid or all-internal distraction devices are technical options. However, they are all based on distraction osteogenesis. Reconstructive techniques restore long-bone continuity by replacing the defect zone with autologous bone, e.g., with a vascularized bone graft or with the technique described by Masquelet. Allografts for defect reconstruction in long bones might also be described as possible options. Due to limited access to allografts in many countries and the authors’ opinion that allografts result in poorer outcomes, this review focuses on autologous techniques and gives an internationally aligned overview of the current concepts in repair or reconstruction techniques of segmental long-bone defects.
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spelling pubmed-105733642023-10-14 Current Management of Diaphyseal Long Bone Defects—A Multidisciplinary and International Perspective Bernd, Rosslenbroich Steffen Chang-Wug, Oh Thomas, Kern John, Mukhopadhaya Johannes, Raschke Michael Ulrich, Kneser Christian, Krettek J Clin Med Review The treatment of defects of the long bones remains one of the biggest challenges in trauma and orthopedic surgery. The treatment path is usually very wearing for the patient, the patient’s environment and the treating physician. The clinical or regional circumstances, the defect etiology and the patient´s condition and mental status define the treatment path chosen by the treating surgeon. Depending on the patient´s demands, the bony reconstruction has to be taken into consideration at a defect size of 2–3 cm, especially in the lower limbs. Below this defect size, acute shortening or bone grafting is usually preferred. A thorough assessment of the patient´s condition including comorbidities in a multidisciplinary manner and her or his personal demands must be taken into consideration. Several techniques are available to restore continuity of the long bone. In general, these techniques can be divided into repair techniques and reconstructive techniques. The aim of the repair techniques is anatomical restoration of the bone with differentiation of the cortex and marrow. Currently, classic, hybrid or all-internal distraction devices are technical options. However, they are all based on distraction osteogenesis. Reconstructive techniques restore long-bone continuity by replacing the defect zone with autologous bone, e.g., with a vascularized bone graft or with the technique described by Masquelet. Allografts for defect reconstruction in long bones might also be described as possible options. Due to limited access to allografts in many countries and the authors’ opinion that allografts result in poorer outcomes, this review focuses on autologous techniques and gives an internationally aligned overview of the current concepts in repair or reconstruction techniques of segmental long-bone defects. MDPI 2023-09-29 /pmc/articles/PMC10573364/ /pubmed/37834927 http://dx.doi.org/10.3390/jcm12196283 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Bernd, Rosslenbroich Steffen
Chang-Wug, Oh
Thomas, Kern
John, Mukhopadhaya
Johannes, Raschke Michael
Ulrich, Kneser
Christian, Krettek
Current Management of Diaphyseal Long Bone Defects—A Multidisciplinary and International Perspective
title Current Management of Diaphyseal Long Bone Defects—A Multidisciplinary and International Perspective
title_full Current Management of Diaphyseal Long Bone Defects—A Multidisciplinary and International Perspective
title_fullStr Current Management of Diaphyseal Long Bone Defects—A Multidisciplinary and International Perspective
title_full_unstemmed Current Management of Diaphyseal Long Bone Defects—A Multidisciplinary and International Perspective
title_short Current Management of Diaphyseal Long Bone Defects—A Multidisciplinary and International Perspective
title_sort current management of diaphyseal long bone defects—a multidisciplinary and international perspective
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573364/
https://www.ncbi.nlm.nih.gov/pubmed/37834927
http://dx.doi.org/10.3390/jcm12196283
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