Narrative review by Schemitsch examining what threshold of bone loss constitutes a 'critical-sized' defect — one that will not heal spontaneously and mandates planned reconstruction. The paper synthesizes clinical trial data and cohort studies to interrogate whether current definitions (>1 cm, >50% cortical circumference) are actually predictive of failure to heal.
2 cm and >50% circumference loss → 0% union rate
When you encounter a tibial diaphyseal defect, size alone is insufficient — consider the full picture: defects approaching or exceeding 2.5 cm with >50% cortical circumference loss in the tibia carry a poor natural history and warrant planned reconstruction, while smaller defects may be observed given that nearly half heal without secondary surgery.
Narrative review by Schemitsch examining what threshold of bone loss constitutes a 'critical-sized' defect — one that will not heal spontaneously and mandates planned reconstruction. The paper synthesizes clinical trial data and cohort studies to interrogate whether current definitions (>1 cm, >50% cortical circumference) are actually predictive of failure to heal.
2 cm and >50% circumference loss → 0% union rate
When you encounter a tibial diaphyseal defect, size alone is insufficient — consider the full picture: defects approaching or exceeding 2.5 cm with >50% cortical circumference loss in the tibia carry a poor natural history and warrant planned reconstruction, while smaller defects may be observed given that nearly half heal without secondary surgery.