Background
Methods
Data collection and extraction
Assessment of publication bias
Quantitative data synthesis
Results
Selection of studies
Authors | Year | Treatment period | Study type | LE | (n) | Age (y) [range] | Male/female | Bone defect location (femur/tibia/humerus/foream/other bones) | FU (mts) |
---|---|---|---|---|---|---|---|---|---|
Ring et al. [16] | 2000 | nr | R-CS | IV | 15 | 48 [22 - 80] | 9/6 | -/-/15/-/- | 31 |
Tu et al. [17] | 2001 | 1990–1993 | R-CS | IV | 48 | 48 [15 - 62] | 40/8 | 10/32/2/4/- | 72 |
Toh et al. [18] | 2001 | 1983–1998 | R-CS | IV | 19 | 53 [21 - 84] | 17/2 | -/19/-/-/- | 98 |
Heitmann et al. [19] | 2002 | nr | R-CS | IV | 12 | 43 [16 - 79] | 7/5 | -/-/12/-/- | tn |
Muramatsu et al. [20] | 2003 | 1985–2000 | R-CS | IV | 13 | 51 [27 - 80] | 6/7 | -/-/13/-/- | tn |
Pelissier et al. [15] | 2003 | 1984–1999 | R(C)-CS | IV | 40 | tn | tn | tn | tn |
Yajima et al. [21] | 2004 | 1976–2000 | R-CS | IV | 20 | 37 [17 - 73] | 16/4 | 9/8/-/2/1 | 64 |
Lee et al. [22] | 2004 | 1982–2001 | R-CS | IV | 51 | 41 [15 - 66] | 48/3 | -/51/-/-/- | nr |
Adani et al. [23] | 2004 | 1993–2000 | R-CS | IV | 11 | 38 [16 - 65] | 5/6 | -/-/-/11/- | tn |
Ring et al. [24] | 2004 | 1983–2001 | R-CS | IV | 35 | 40 [21 - 66] | 18/17 | -/-/-/35/- | 43 |
Yazar et al. [25] | 2004 | 1993–2000 | R-CS | IV | 61 | 37.5 [10 - 82] | 42/19 | 7/49/-/-/6 | 58 |
Safoury [26] | 2005 | nr | R-CS | IV | 18 | 34 [22 - 46] | 16/2 | -/-/-/18/- | 36 |
Jones et al. [27] | 2006 | 2000–2003 | RCT | II | 15 | 38 [18 - 71] | 13/2 | -/15/-/-/- | tn |
El-Sayed et al. [28] | 2007 | nr | R-CS | IV | 12 | 25 [12 - 40] | 11/1 | -/8/2/2/- | 24 |
Ristiniemi et al. [29] | 2007 | 2000–2004 | R-CS | IV | 23 | 35 [14 - 75] | 16/7 | -/23/-/-/- | nr |
Adani et al. [30] | 2008 | 1994–2004 | R-CS | IV | 13 | 37 [21 - 62] | 10/3 | -/-/13/-/- | nr |
El-Gammal et al. [48] | 2008 | 1995–2004 | R(C)-CS | IV | 13 | 31.5 [nr] | 11/2 | -/13/-/-/- | 38 |
Ryzewicz et al. [31] | 2009 | 1998–2007 | R(C)-CS | IV | 18 | 34.2 [18 - 51] | 11/7 | -/18/-/-/- | nr |
Allende et al. [32] | 2009 | 1996–2008 | R-CS | IV | 10 | 32.8 [11 - 56] | 9/1 | -/-/4/6/- | tn |
Cavadas et al. [33] | 2010 | 2000–2008 | R-CS | IV | 41 | nr [17 - 64] | 39/2 | -/41/-/-/- | nr |
McCall et al. [34] | 2010 | 2003–2007 | P-CS | IV | 21 | 30.6 [nr] | 13/8 | 5/15/-/1/- | nr |
Sun et al. [35] | 2010 | 2005–2007 | R-CS | IV | 10 | 31 [16 - 50] | 9/1 | 3/7/-/-/- | 26 |
Apard et al. [36] | 2010 | nr | R-CS | IV | 12 | 40.6 [18 - 74] | 10/2 | -/12/-/-/- | 39 |
Zhen et al. [37] | 2010 | 2000–2007 | R-CS | IV | 28 | 31.5 [17 - 56] | 21/7 | -/28/-/-/- | 36 |
Chai et al. [38] | 2010 | 2005–2007 | R-CS | IV | 16 | 31 [16 - 50] | 10/6 | -/9/-/4/3 | 18 |
Georgescu et al. [39] | 2011 | 1997–2007 | R-CS | IV | 44 | 30.5 [5 - 66] | 33/11 | 3/22/5/3/11 | 23 |
Chung et al. [40] | 2011 | 1989–2007 | R-CS | IV | 10 | 25.3 [16 - 43] | 8/2 | -/10/-/-/- | 41 |
Niu et al. [41] | 2011 | 2003–2008 | R-CS | IV | 19 | 38.9 [18 - 61] | 12/7 | 8/11/-/-/- | nr |
Liang et al. [42] | 2012 | 1996–2006 | R-CS | IV | 16 | 33.3 [21 - 46] | nr | 16/-/-/-/- | 83 |
Gulan et al. [43] | 2012 | 1991–1998 | R-CS | IV | 10 | 30 [22 - 51] | 10/0 | -/10/-/-/- | 144 |
Liang et al. [44] | 2012 | 2001–2007 | R-CS | IV | 14 | 34.3 [23 - 48] | 11/3 | 14/-/-/-/- | 67 |
Gao et al. [45] | 2012 | 2004–2006 | R-CS | IV | 18 | 34 [16 - 56] | 13/5 | 7/11/-/-/- | 40 |
Niu et al. [46] | 2012 | 1993–2008 | R-CS | IV | 22 | 33.8 [17 – 60] | 14/8 | -/-/22/-/- | 39 |
Özaksar et al. [47] | 2012 | 1993–2009 | R-CS | IV | 21 | 32 [16 - 47] | 19/2 | -/21/-/-/- | 74 |
Publication bias
Bone union rate
Authors |
n
| BD Mean (cm) | Treatment type | Donor area/associated technique (n cases per treatment) | Primary union | Secondary union |
---|---|---|---|---|---|---|
Nonvascularized bone graft | ||||||
Ring et al. [16] | 15 | 3 [2–6] | ICBG | ICBG (15) | 93 % | 93 % |
Pelissier et al. [15] | 16 | 4.3 [nr] | ICBG | ICBG (16) | 75 % | 81 % |
Jones et al. [27] | 15 | 4 [2.5–7] | ICBG | ICBG (15) | 67 % | 93 % |
Ryzewicz et al. [31] | 18 | 3.8 [2–6] | ICBG | ICBG (18) | 89 % | 94 % |
Niu et al. [46] | 22 | tn [tn] | ICBG | ICBG (22) | 95 % | 100 % |
Gulan et al. [43] | 10 | 4 [2–7] | ICBG | ICBG (10) | 100 % | 100 % |
Ring et al. [24] | 35 | 2.2 [1–6] | Multiple DS | ICBG (33)/Ulna (4) | 100 % | 100 % |
El-Sayed et al. [28] | 12 | 7 [6–10] | Multiple DS | ICBG (8)/Fibula (12) | 92 % | 92 % |
Niu et al. [41] | 19 | nr [nr] | Multiple DS | ICBG (19)/Fibula (2) | 95 % | 95 % |
Ristiniemi et al. [29] | 23 | 5.2 [3.5–10] | ICBG + biomembrane | ICBG (23)/biomembrane (23) | 61 % | 96 % |
Allende et al. [32] | 10 | 3.2 [1–7] | ICBG + biomembrane | ICBG (10)/biomembrane (10) | 100 % | 100 % |
Apard et al. [36] | 12 | 8.7 [6–15] | ICBG + biomembrane | ICBG (12)/TCF (4)/biomembrane (12) | 92 % | 92 % |
McCall et al. [34] | 21 | 6.6 [2–14.5] | RIA + biomembrane | RIA (21)/biomembrane (18) | 48 % | 81 % |
Vascularized bone graft | ||||||
Heitmann et al. [19] | 12 | 9.2 [8–12] | Free one DS | Fibula (12) | 75 % | 92 % |
Lee et al. [22] | 51 | 10.5 [4.5–17] | Free one DS | Fibula (51) | 92 % | 98 % |
Adani et al. [23] | 11 | 8.7 [6–13] | Free one DS | Fibula (11) | 73 % | 82 % |
Safoury [26] | 18 | nr [nr] | Free one DS | Fibula (18) | 94 % | 100 % |
Adani et al. [30] | 13 | 10.5 [6–16] | Free one DS | Fibula (13) | 69 % | 92 % |
El-Gammal et al. [48] | 13 | 12.6 [nr] | Free one DS | Fibula (13) | nr | 100 % |
Sun et al. [35] | 10 | 9.5 [6–17] | Free one DS | Fibula (10) | 90 % | 100 % |
Zhen et al. [37] | 28 | nr [9–17] | Free one DS | Fibula (28) | 100 % | 100 % |
Chai et al. [38] | 16 | 13.8 [5–20] | Free one DS | Fibula (16) | 100 % | 100 % |
Liang et al. [44] | 14 | 6.9 [5–9] | Free one DS | Fibula (14) | 100 % | 100 % |
Liang et al. [42] | 16 | 16.4 [14–20] | Free one DS | Fibula (16) | 94 % | 100 % |
Gao et al. [45] | 18 | 9.2 [7–14] | Free one DS | Fibula (18) | 100 % | 100 % |
Özaksar et al. [47] | 21 | 10 [6–18] | Free one DS | Fibula (21) | 81 % | 95 % |
Toh et al. [18] | 19 | 4.9 [1–11] | Pedicle one DS | Fibula (19) | 95 % | 100 % |
Chung et al. [40] | 10 | 5.4 [4–8] | Pedicle one DS | Fibula (10) | 100 % | 100 % |
Yajima et al. [21] | 20 | 9.6 [3–24] | Free + pedicle one DS | Free fibula (16)/pedicle fibula (4) | 85 % | 90 % |
Georgescu et al. [39] | 44 | 8.2 [4–14] | Free one DS | Free rib (44) | 98 % | 98 % |
Pelissier et al. [15] | 24 | 9.8 [nr] | Free multiple DS | Fibula (12)/iliac (10)/arm (2) | 88 % | 88 % |
Yazar et al. [25] | 62 | 11.7 [6–18] | Free multiple DS | Fibula (50)/iliac (6)/rib (6) | 87 % | 95 % |
Cavadas et al. [33] | 41 | nr [4–17] | Free multiple DS + biomembrane | Fibula (38)/iliac (3)/biomembrane (32) | 98 % | 100 % |
Nonvascularized and vascularized bone graft | ||||||
Muramatsu et al. [20] | 13 | 1.8 [1–4] | Free multiple DS + ICBG | Fibula (8)/femur (4)/scapula (1)/ICBG (8) | 85 % | 100 % |
Tu et al. [17] | 48 | 10.2 [6.5–19] | Free multiple DS + ICBG | Fibular (41)/iliac (4)/Rib (3)/ICBG (48) | 94 % | 100 % |