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Objectives and questions: Sheep tibial fracture models are essential for preclinical orthopedic and trauma research due to their close biomechanical and biological resemblance to human long-bone healing. This systematic review aimed to evaluate fixation techniques, defect models, and postoperative treatment strategies in tibial osteotomy models, with the goal of identifying methodological patterns relevant for their translational applicability in musculoskeletal research.

Material and methods: A systematic search of PubMed and Embase identified studies investigating diaphyseal tibial osteotomies in sheep. Data extraction focused on fixation type, defect geometry, animal body weight, and postoperative analgesic, antibiotic and care protocols. Three independent reviewers performed the systematic review using CADIMA to enhance sensitivity and consistency in the initial screening. Parameters related to the experimental design as well as reporting completeness were evaluated according to predefined criteria.

Results: Out of 3,007 screened records, 119 studies fulfilled the inclusion criteria. External fixation was used in 46.7% of studies, plate fixation in 30.8%, and intramedullary nailing in 23.3%. Most models were simple osteotomies (77.5%), whereas drill holes, wedge osteotomies and complex fracture analogs accounted for the remainder. In 36.6% critical-size defects were modulated. Mean animal weight was 54.8 kg (range 17.5–96.1 kg) with studies involving heavier animals showed a tendency toward external fixation regardless of defect configuration. Reporting of postoperative management was inconsistent: only 39 studies reported analgesic regimens and 32 provided details on antibiotic administration, typically limited to short perioperative courses.

Discussion and conclusions: This review demonstrates substantial methodological variation and incomplete reporting in sheep tibial osteotomy models. No clear gold standard for fixation or postoperative care was identified. Notably, postoperative analgesic and antibiotic protocols often do not reflect clinical practice, highlighting the need for standardized and better-documented experimental designs. For orthopedic and trauma research, these findings highlight the need for standardized, clinically aligned experimental protocols to improve reproducibility, comparability, and translational value. Enhanced documentation regarding postoperative care is essential to fully leverage the potential of sheep models in translational musculoskeletal research.