Background: The management of diaphyseal and distal tibial defects and non-unions is a significant challenge. Traditional treatments, such as distraction osteogenesis or Masquelet, are characterized by extended treatment times and elevated complication rates. Innovative approaches, such as customized 3D-printed titanium implants, are often required to restore structural integrity and function. This systematic review aimed to analyze the results achieved to date with this technique. Methods: A systematic review of the literature written in English was performed in PubMed, Scopus, and Cochrane to identify all cases of tibial non-unions or defects treated with customized 3D-printed titanium implants, excluding defects from tumor resection. Studies with a minimum of 12 months of follow-up were included. Results: The causes of treatment were infection in 10 patients, non-union in 6 patients, and severe bone loss after trauma in 3 cases. The size of the defect ranged from 3 to 8.5 cm. Osteointegration was 100% in all studies. The mean time to union was 5.3 months. The complication rate was 16%. Conclusions: Good results were reported in most patients. However, the data are insufficient to define the role of customized 3D-printed implants compared to traditional techniques. Further studies comparing them are needed to draw explicit guidelines.

Introduction: Segmental tibial defects pose significant challenges in orthopedic surgery due to their complexity and high complication rates. This systematic review aimed to evaluate both the effectiveness and outcomes of distraction osteogenesis (D.O.) and the Masquelet technique in treating post-traumatic segmental tibial defects. Materials and Methods: A literature search was performed on PubMed, Scopus, and Cochrane. Relevant retrospective and prospective observational studies with a minimum of 12 months follow-up were included. The primary outcome was bone union rate; the secondary outcomes were the type and rate of complications and the clinical and radiological outcomes. Results: Twenty-seven studies met the inclusion criteria, 18 studies reported data on D.O. and 9 on the Masquelet technique. D.O. demonstrated an overall union rate of 79.4% across 422 patients, and the Masquelet technique demonstrated an overall bone union rate of 85% across 113 patients. For D.O., on average, there was one complication per patient, and with the Masquelet technique, there were 0.5 complications per patient. Conclusions: D.O. and the Masquelet technique are the main treatment options for post-traumatic segmental tibial defects. Although union rates are similar, the Masquelet technique showed fewer complications. Treatment choice should consider patient-specific factors and more comparative studies are needed.

Background: Distraction osteogenesis (DO) and the Masquelet technique are currently the preferred treatment options for bone defects larger than 5 cm. Methods: Between January 2019 and December 2023, 19 patients were treated with DO for post-traumatic tibial defects at our institution. The results were evaluated using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Results: Patients’ mean age was 32.42 years. The mean defect size was 4.8 cm (range 3.2–8.1 cm), and the mean external fixation time was 21.31 weeks. Bone union was reached on average after 25.9 weeks. The mean follow-up time was 3.7 years. The mean leg length discrepancy at the final follow-up was 0.83 cm. Using the ASAMI system, the functional results were excellent in eight patients, good in eight, and fair in two, with one case of failure; the bone results were excellent in ten patients, good in six, fair in two, and poor in one. Conclusions: DO for the treatment of tibial defects has the potential to yield favourable outcomes, provided that the method is performed correctly. Multicentre prospective studies would allow for more definitive conclusions to be made.