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Meta-Analysis
. 2016 Nov 9;17(1):465.
doi: 10.1186/s12891-016-1312-4.

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Matheus Lemos Azi  1 , Alessandro Aprato  2 , Irene Santi  3 , Mauricio Kfuri Jr  4   5 , Alessandro Masse  2 , Alexander Joeris  3
Affiliations
Meta-Analysis

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Matheus Lemos Azi et al. BMC Musculoskelet Disord. .

Abstract

Background: This meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques.

Methods: The PubMed and the Cochrane Library databases were searched using the terms: 'fracture' AND ('bone loss' OR 'defect' OR 'defects') AND 'bone graft', restricted to English language, to human species, and to a publication period from January 1999 to November 2014. Data were extracted by one of the reviewers and then checked by the second. A quality of evidence score and a methodology score were used. Heterogeneity was assessed. A random effects model approach was used to combine estimates.

Results: Out of 376 selected studies only 34 met the inclusion criteria. The summary pooled union rate was 91 % (95 % CI: 87-95 %) while union rate after additional procedures raised to 98 % (95 % CI 96-99 %). No association between union rate and bone defect size was found. (Univariable regression model: vascularized: P = 0.677; non-vascularized: 0.202. Multivariable regression model: vascularized: P = 0.381; non-vascularized: P = 0.226). Vascularized graft was associated with a lower risk of infection after surgery when compared to non-vascularized graft (95 % CI 0.03 to 0.23, p < 0.001).

Conclusion: The results of this meta-analysis demonstrate the effectiveness of autologous graft for bone defects. Furthermore, from the available clinical evidence bone defect size does not seem to have an impact on bone union when treated with autologous bone graft techniques.

Keywords: Bone graft; Bone reconstruction; Large bone defects; Segmental bone defect.

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Figures

Fig. 1
Fig. 1
Flowchart of literature review
Fig. 2
Fig. 2
Funnel plot comparing proportion versus the standard error of proportion for the outcome of (a) primary union and (b) secondary union. The assessment of the Egger test was coupled with an informal visual inspection of the funnel plot where circles represent studies included in the meta-analysis. The solid vertical line indicates no union in terms of proportion. The outer dashed line indicate the triangular region within which 95 % of studies are expected to lie in absence of both bias and heterogeneity (random effect pooled proportion ± 1.96 × standard error of pooled proportion). Asymmetry about the pooled proportion line is consistent with the presence of publication bias
Fig. 3
Fig. 3
Forest plot of bone union (% of union rates) in patients with vascularized and non-vascularized bone graft (random effects model). a Primary union b Secondary union
Fig. 4
Fig. 4
Forest plot of the odds ratio of bone infection before and after bone graft treatment stratified by type of graft (vascularized and non-vascularized)
See this image and copyright information in PMC

References

    1. Myeroff C, Archdeacon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg Am. 2011;93:2227–36. doi: 10.2106/JBJS.J.01513. - DOI - PubMed
    1. Ashman O, Phillips AM. Treatment of non-unions with bone defects: Which option and why? Injury. 2013;44(1):S43–5. doi: 10.1016/S0020-1383(13)70010-X. - DOI - PubMed
    1. Mauffrey C, Barlow BT, Smith W. Management of segmental bone defects. J Am Acad Orthop Surg. 2015;23(3):143–153. - PubMed
    1. Cox G, Jones E, McGonagle D, et al. Reamer-irrigator-aspirator indications and clinical results: A systematic review. Int Orthop. 2011;35(7):951–6. doi: 10.1007/s00264-010-1189-z. - DOI - PMC - PubMed
    1. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin N Am. 2010;41(1):27–37. doi: 10.1016/j.ocl.2009.07.011. - DOI - PubMed

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