Narrative review examining four unresolved questions in bone defect management: how to define a critical-size defect, how to execute the Masquelet (induced membrane) technique, when and how to use biologics, and how to approach infected defects. Synthesizes available evidence to expose where consensus is absent and where practical guidance can still be offered.
When you see a tibial shaft defect ≥2.5 cm, expect it won't heal without intervention and plan for staged reconstruction — the Masquelet technique with RIA graft is the best-supported option, but time the second stage at 6–8 weeks and optimize host factors (albumin, Vitamin D, HbA1c, ABI) before grafting.
For infected defects, always send a minimum of 3–5 deep tissue biopsies at debridement and choose bioabsorbable antibiotic delivery over PMMA beads when possible to reduce reoperation burden.
Narrative review examining four unresolved questions in bone defect management: how to define a critical-size defect, how to execute the Masquelet (induced membrane) technique, when and how to use biologics, and how to approach infected defects. Synthesizes available evidence to expose where consensus is absent and where practical guidance can still be offered.
When you see a tibial shaft defect ≥2.5 cm, expect it won't heal without intervention and plan for staged reconstruction — the Masquelet technique with RIA graft is the best-supported option, but time the second stage at 6–8 weeks and optimize host factors (albumin, Vitamin D, HbA1c, ABI) before grafting.
For infected defects, always send a minimum of 3–5 deep tissue biopsies at debridement and choose bioabsorbable antibiotic delivery over PMMA beads when possible to reduce reoperation burden.