Ring Fixator Bone Transport Is Associated With Fewer Unplanned Major Reoperations Than Masquelet in the Treatment of Segmental Bone Defects of the Tibia

OBJECTIVE: To determine whether bone transport or Masquelet results in higher rates of major unplanned reoperations for the treatment of segmental tibial bone defects ≥4 cm in length. METHODS: Design: Retrospective cohort. Setting: Level I trauma center. Patient Selection Criteria: Adult patients with segmental tibial defects (OTA/AO 41, 42, 43) ≥4 cm who underwent surgical treatment with ring fixator bone transport or Masquelet between 2011 and 2022 with a minimum 1-year follow-up were included. Outcome Measures and Comparisons: The primary outcome was a major unplanned reoperation after corticotomy (bone transport) or autografting (Masquelet), including below knee amputation, surgical debridement for deep infection, or surgical intervention for nonunion. Ring fixator bone transport and Masquelet were compared using multivariable logistic regression, adjusting for defect size as a potential confounder. RESULTS: Twenty-four patients treated with bone transport [mean age 40 years (18–66), 100% men] and 22 patients treated with Masquelet [mean age 42 years (22–71), 91% men] were included. Defect etiology was identified as acute traumatic in 25 patients (54%) and postinfectious in 21 patients (46%) ( P = 0.23). The median defect size was 7.2 cm (interquartile range 6.1–10.1) for transport and 5.8 cm for Masquelet (interquartile range 4.7–8.0) ( P = 0.08). Bone transport was associated with an 85% reduction in the odds of a major unplanned reoperation compared to treatment with the Masquelet technique (odds ratio, 0.15; 95% confidence interval, 0.03–0.58; P = 0.01). Bone transport patients underwent a mean of 0.38 major unplanned reoperations compared to 0.91 in the Masquelet group. Reoperation for deep infection occurred significantly less in the bone transport group (21%) compared to the Masquelet group (46%) (odds ratio, 0.18; 95% confidence interval, 0.03–0.76; P = 0.03). CONCLUSIONS: Bone transport was associated with a reduction in major reoperations compared to Masquelet for segmental tibial bone defects. This finding may have been driven by fewer surgeries for infection in the bone transport group. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.