Work

Risk-Stratified Predictive Analysis of Docking Site Outcomes in Lower Extremity Bone Transport: Identifying High-Risk and Low-Risk Zones for Large Segmental Defect Management

Year: 2026

Type: article

Abstract: Background Reconstruction of limbs with extensive bone loss often requires complex surgical procedures, which can be technically demanding, time-consuming, and physically and psychologically burdensome for patients. Historically, the lack of alternatives for large bone defects often led to primary amputation. Modern musculoskeletal practice allows for reconstruction using autologous or allogeneic bone grafts, or through more complex procedures such as the Masquelet technique or distraction osteogenesis. However, these methods share a common challenge: the need for a docking site procedure in cases of insufficient bony fusion of the transport segment. The aim of this study was to identify predictive factors for the need of a docking site procedure. Methods A retrospective analysis was conducted on 93 patients treated for lower extremity bone defects using segmental bone transport between January 2013 and June 2023. Patients of all ages and both genders were included, regardless of the etiology and size of the defect. The need for a docking site procedure was analyzed using logistic regression, ROC analysis, and ANOVA. Results The study included 93 patients (73 male, 19 female) aged 7 to 83 years. The mean defect size was 76.46 mm (range: 12.1 to 225.1 mm). The mean transport duration was 149.97 days, with a mean transport speed of 0.61 mm/day. A docking site procedure was performed in 64.1% of patients. Significant predictors for the need of a docking site procedure were age (p = 0.024), vascular injury (p = 0.009), transport duration (p = 0.001), and transport speed (p < 0.001). ROC analysis showed that transport speed (AUC = 0.931) and transport duration (AUC = 0.911) were the most reliable predictors. Conclusion The study identified transport duration and speed as key predictive factors for the need of a docking site procedure. A transport duration exceeding 290.5 days significantly increased the likelihood of requiring a docking site procedure. These findings can help optimize treatment planning and improve long-term limb preservation.

Source: Journal of Clinical Medicine

DOI: 10.3390/jcm15020487