Priority 17 from the Complex Fractures PSP

UNCERTAINTY: What is the best bone defect reconstruction option in the acute treatment of complex fractures?  (JLA PSP Priority 17)
Overall ranking 17
JLA question ID 0105/17
Explanatory note Complex fractures may result in bone defects whereby a region of bone is destroyed or must be excised by the treating surgeon as it has lost its blood supply. Several treatment options exist for these situations such as fixation with new morphology, cadaveric bone graft, autologous bone graft, or bone free flaps. 

NG37 examined the evidence for staging and treating Pilon fractures. Evidence for all outcomes included in the review was very imprecise. Overall, the NICE committee felt the Low quality of the evidence underlined the need for research in this area.

NICE Guideline 37 Fractures (complex): assessment and management

An International, Multicenter, Prospective Registry on Post-traumatic Long Bones Defects (registry data)

Enhancement of Bone Regeneration and Healing in the Extremities by the Use of Autologous BonoFill-II (single group assignment trial in non-complex fractures)

Health Research Classification System category Injuries and accidents
Extra information provided by this PSP
Original uncertainty examples bone transport methods- Stryde VS circular frame- masquelet VS bone transport 
Submitted by 1 x Surgeon/Doctor
PSP information
PSP unique ID 0105
PSP name Complex Fractures
Total number of uncertainties identified by this PSP. 58  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 8th June 2021