This 2015 JAAOS narrative review by Mauffrey et al. synthesizes the surgical options for segmental bone defects — from small post-traumatic voids to massive oncologic resection gaps — and provides a size-based decision framework to guide technique selection among autograft, induced membrane, distraction osteogenesis, vascularized fibular graft, acute shortening, and amputation.
When you encounter a post-traumatic segmental bone defect, size drives your algorithm: under 5 cm use autograft, 5–10 cm consider Masquelet or Ilizarov based on soft-tissue envelope and patient tolerance for external fixation, and over 10 cm Masquelet or vascularized fibula are your primary options — but counsel every patient that complications are nearly universal regardless of technique chosen.
This 2015 JAAOS narrative review by Mauffrey et al. synthesizes the surgical options for segmental bone defects — from small post-traumatic voids to massive oncologic resection gaps — and provides a size-based decision framework to guide technique selection among autograft, induced membrane, distraction osteogenesis, vascularized fibular graft, acute shortening, and amputation.
When you encounter a post-traumatic segmental bone defect, size drives your algorithm: under 5 cm use autograft, 5–10 cm consider Masquelet or Ilizarov based on soft-tissue envelope and patient tolerance for external fixation, and over 10 cm Masquelet or vascularized fibula are your primary options — but counsel every patient that complications are nearly universal regardless of technique chosen.