A Narrative Review of Endoprosthetic Reconstruction for Post-Traumatic Segmental Bone Defects After Fracture-Related Infection

Segmental bone loss after fracture-related infection (FRI) may require biological reconstruction, endoprosthetic replacement, or amputation. This narrative review examines antimicrobial management, surgical selection, and outcomes of megaprosthetic reconstruction, with emphasis on adult lower-limb periarticular defects. Evidence is distinguished as direct FRI evidence, mixed clinical evidence, or indirect evidence from oncological reconstruction and periprosthetic joint infection (PJI). Megaprostheses provide immediate structural stability and may facilitate early weight-bearing in selected patients with extensive joint involvement, limited capacity for prolonged rehabilitation, or failed biological reconstruction. However, infection, soft-tissue failure, and mechanical complications remain substantial concerns. The frequently cited PJI incidence of 15–43% comes from heterogeneous megaprosthesis populations and is not an estimate specific to reconstruction after post-traumatic FRI. Small FRI series report encouraging short-term infection control, whereas mixed and megaprosthesis PJI cohorts demonstrate recurrent infection and further salvage surgery. Staged reconstruction is commonly reported, but comparisons between surgical strategies are vulnerable to selection bias, small samples, and inconsistent outcome definitions. Biological reconstruction outcomes provide contextual benchmarks rather than evidence of comparative superiority. Overall, megaprosthetic reconstruction is a reasonable salvage option when the expected benefit of immediate stability and preservation of joint motion outweighs the risks of infection and later implant failure. Treatment should integrate adequate debridement, appropriate systemic and local antimicrobial therapy, viable soft-tissue coverage, host optimization, and shared decision-making; the available evidence does not establish a universally preferred reconstruction algorithm.