The reconstruction of critical bone loss: the holy grail of orthopaedics

[摘要] The reconstruction of segmental long bonedefects demands a substantial investmentof time and resources for both patients andhealthcare providers.1 The post hoc analysisof the SPRINT trial has been particularly influential in advancing our understanding of thismatter.2 At present, defects larger than 2 cmin length and with more than 50% circumferential bone loss are considered criticalbone defects and unlikely to heal withoutfurther intervention.3 Ferreira and Tanwar1recently proposed a classification systemand treatment algorithm that considers thesize of the bone defect (< 2 cm, 2 to 6 cm,6 to 12 cm, or > 12 cm), soft-tissue quality(no deficit, defect requiring reconstruction,or unreconstructable defect), and host type(no compromise, local or systemic compromise, or treatment would be worse than thedisease for the patient). It is proposed thatthe subsequent management is tailored toaddress all the elements identified in the classification system.

[学科分类] 骨科学

[关键词] Bone regeneration;Biologics;Bone loss;bone loss;bone defects;fracture-related infection;limb reconstruction;external fixation;debridement;Infection;Bone transport;bone grafting;amputation