Current and traditional reconstructive techniques for bone diaphyseal defects: selection criteria, advantages, outcomes. A study of 24 cases.

PURPOSE: Diaphyseal bone defects of the upper and lower limbs represent a significant reconstructive challenge, often arising from high-energy trauma, posttraumatic osteomyelitis, or postoperative bone necrosis. This study evaluates the applicability, advantages, limitations, and outcomes of various reconstructive techniques for segmental diaphyseal defects in a cohort of 24 patients.

METHODS

Between 2004 and 2011, 24 patients (age range 15-74 years) with diaphyseal defects ranging from 4 to 15 cm were treated using the following reconstructive approaches: 1.Ilizarov bone transport (IBT), 2.Taylor spatial Frame bone transport (TSFBT) (one Trifocal), 3.Εxternal fixation bone transport (ExFixBT), 4.free vascularized fibular graft (FVFG), 5.pedicle vascularized serratus-rib transfer i, 6.Masquelet-modified technique, 7.demineralized blocks or frozen cadaveric allografts. 8.Modified Papineau procedure + flaps with Dynamic (TSFBT) or static Taylor Frame (with TSFBT or with static Taylor Frame). Upper limb defects (n = 8) were managed predominantly with microsurgical techniques, while lower limb defects (n = 16) employed bone transport strategies. Clinical evaluation incorporated the Gustilo classification, Mangled Extremity Severity Score (MESS) for lower limbs, and SATTy scoring for upper limbs. Functional outcomes were assessed using Quick DASH (upper limb) and Lower Extremity Functional Scale (LEFS, lower limb) scores after a minimum 5-year follow-up.

RESULTS

Upper limb reconstructions achieved bone healing in all cases, with Quick DASH scores showing two excellent, one good, three satisfactory, and two borderline satisfactory outcomes. Lower limb reconstructions also achieved successful union, with LEFS outcomes ranging from mild to severe difficulty; no patient was entirely disabled. Techniques were tailored according to defect size, infection status, soft tissue condition, and surgical expertise. Notably, modified Papineau open cancellous grafting provided reliable resolution in cases of persistent osteomyelitis. Complex reconstructions, including simultaneous nerve and bone grafting, demonstrated successful functional recovery.

CONCLUSIONS

Successful management of diaphyseal bone defects relies on individualized selection of reconstructive techniques based on defect characteristics, infection status, and multidisciplinary expertise. Close collaboration between orthopedic and microsurgical teams is essential. Historically underutilized techniques, such as the Papineau procedure, remain valuable options in the setting of chronic infection. Careful, patient-specific planning enables favorable anatomical and functional outcomes.