Supplemental Digital Content 2. Union definition by study
Study, year Union definition Additional bone graf
procedures
If the tibia healed following more than
one bone graf, did the authors consider
the case a success?
Other procedures
Apard,16 2010 - - no 1 patient underwent modified Iliarzov bone transport; 2
cases of infection required changing of their nail and abx Stafford,36 2010 clinical (pain-free full weight bearing) and radiographic
(bridging callus on 3/4 cortices)
- no on average, 2.8 previous surgeries were performed prior
to graft insertion
Karger,24 2012 - - - a mean 6.11 interventions were necessary to obtain
union; malalignment was observed in 15 patients requiring surgical correction in three cases after union
El-Alfy,19 2015 - 5 additional bone graft
procedures
yes 1 patient underwent fibular osteotomy of the fibula
Moghaddam,28 2015 consolidation present in at least 3 of 4 cortices - yes average of 6.7 surgeries prior to bone graft Olesen,31 2015 radiographic consolidation 1 additional bone graft
procedure
no -
Giannoudis,20 2016 radiographic: 3/4 cortices showed callus formation (bridging)
pain free mobilization
No additional bone grafting n/a -
Gupta,22 2016 when both clinical (absence of abnormal mobility and absence of pain on weight bearing) and radiographic (when graft unites with host bone at both ends) union
was present
1 additional bone graft procedure
No 2 patients underwent Ilizarov bone transport
Wang,39 2016 radiographic: bridging callus on 3 or more cortices clinical: pain-free full weight-bearing and lack of
tenderness on physical examination
no additional bone grafting n/a -
Yeganeh,40 2016 radiographically (welding 3/4 cortices in lateral and full- face radiography) and physical examination (ability of
weight bearing without pain and instability)
- - -
Cho,17 2017 radiograph (consolidation of the grafted bone on three or more cortices)
- No -
Luo,25 2017 bridging of callus on 3/4 cortices and pain-free, full weight bearing
- - 7 patients required a second debridement before grafting
Ma,26 2017 clinically (the ability to walk without aids and no pain or tenderness at the site) and radiographically (a solid bridging callus connecting the fracture fragments in both
the anteroposterior and lateral views)
no additional bone grafting n/a -
Morris,29 2017 - - no 4 patients underwent exchange nailing
Muhlhausser,12 2017 bridging bone on a minimum of 3 cortices in anteroposterior and lateral radiographic views
no additional bone grafting n/a patients needed several reoperations (median of 12) with soft tissue debridements and reconstruction before the
spacer and the bone graft could be implanted
Qiu,13 2017 radiographic consolidation no additional bone grafting n/a -
Tong,37 2017 radiograph showing solid docking-site union and a - - -
minimum of 3 complete cortices Van Niekerk,38 2017 radiographic: Fishgrund's criteria with 3/4 cortices
continuous and at least 2 mm thick
- - -
Wang,14 2017 radiographic healing as bridging callus on three of four cortices and clinical healing as pain-free fill weight
bearing
no additional bone grafting n/a 2 cases required repeated debridement before grafting due to recurrent infection
El-Alfy,18 2018 radiograph 1 additional bone graft
procedure
no -
Sasaki,34 2018 radiographic healing (bridging callus on 3/4 cortices) - - -
Siboni,35 2018 - 9 additional bone graft
procedures
yes 11 patients underwent multiple complementary procedures
Gavaskar,1 2019 radiographic consolidation 2 additional bone graft procedures
yes -
Giotikas,21 2019 presence of 3 cortices in continuity on the anteroposterior and lateral x-rays and concomitant ability of the patient to fully weight-bear without pain
- - -
Gupta,23 2019 ability to painlessly bear weight on affected limb without support along with bridging of 3 cortices on x-ray
5 additional bone graft procedures
no -
Masquelet,2 2019 - - yes -
Mathieu,27 2019 pain-free full weight bearing and bridging callus on 3/4 cortices
7 additional bone healing procedures were required, including 6 intertibiofibular
grafting
yes mean number of 2.9 debridements required before stage 1
Morwood,30 2019 clinical and radiographic union - yes -
Piacentini,32 2019 at least 2 healed cortices - no -
Raven,33 2019 bony consolidation - - -
