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Background: Large bone defects (> 4 cm) can occur after trauma, resection for non union of a fracture, infection, etc. A precise treatment protocol is not available due to big differences between patients and the rarity of these defects, so an individualized program is necessary. Objectives: In this review, we compared the most important and common treatment options based on complications, healing rate, treatment duration, and analyzed a retrospective data set on patients treated with the Ilizarov technique. Methods: We performed a literature search (non systematic) in Pubmed for the Masquelet technique, the Ilizarov technique, the vascularized bone graft technique and the ATMP technique. Furthermore, we analyzed 57 files of patients treated with the Ilizarov technique (oncological and congenital cases not included) in UZLeuven (University Hospitals Leuven) between 2008 and 2018. Results: The treatments have different advantages and disadvantages, each specific to the technique. Union rates are comparable (approximately 90%). In comparison to the literature results, amputation, infection during treatment and refracture where significantly higher in our population. Discussion: Since all treatments have comparable success rates (union), the decision about which treatment is preferable should be based on extensive analysis of the bone defect. The patient will benefit the most of an individual treatment taking into account the characteristics of the defect.