A novel technique for reimplanting extruded bone fragments in open fractures

Rathore, Sameer; Reddy, Indukuri Viswanatha; Kumar, Alok

doi:10.1016/j.tcr.2016.05.006

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…[ 23 ] Methods on how to treat and reimplant large extruded segments of bone in an acute and delayed fashion in the open fracture setting have been described in the literature and have demonstrated good results despite going against popular belief; however, this evidence is largely low-level, based on case reports and case series. [ 24 – 27 ]…”

Section: Acute Assessment and Managementmentioning

confidence: 99%

Managing bone loss in open fractures

Adamczyk¹,

Meulenkamp²,

Wilken³

et al. 2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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Segmental bone loss continues to pose substantial clinical and technical challenges to orthopaedic surgeons. While several surgical options exist for the treatment of these complex patients, there is not a clear consensus or specific guidelines on the optimal management of these injuries as a whole. Many factors must be taken into consideration when planning surgery for these individuals. In order for these techniques to yield optimal results, each injury must be approached in a step-wise and multidisciplinary fashion to ensure that care is taken in bone and wound bed preparation, that soft tissues are healthy and free of contaminants, and that the patient's medical condition has been optimized. Through this article, we will answer relevant questions and discuss common obstacles and challenges encountered with these complex injuries. We will also review the many treatment options available or in development to address this problem.

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Section: Acute Assessment and Managementmentioning

confidence: 99%

Managing bone loss in open fractures

Adamczyk¹,

Meulenkamp²,

Wilken³

et al. 2020

OTA International: The Open Access Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

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Successful sterilization and immediate reimplantation of extruded femoral diaphyseal segment: A case report and review of literature

Sodhai

Pradhan

Sancheti

et al. 2020

Journal of Orthopaedics, Trauma and Rehabilitation

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Extrusion of bone is a rare situation in open fractures due to high energy trauma. There are few studies, reporting successful reimplantation of the extruded bone segment using various sterilization and fixation protocols. However, there are no definitive treatment strategies for this challenging situation. We report a case of 30-year-old male patient with grade IIIB compound right distal femur fracture with an extruded long bone segment, who was treated with successful sterilization and immediate reimplantation of an extruded long diaphyseal segment of distal femur following extensive cleaning with sterile normal saline, removal of debris with scrubbing by sterile brush, soakage in the broad-spectrum antimicrobial solution for 30 min, sterilization by autoclaving at 121°C for 45 min, and reimplantation during stable internal fixation with lateral distal femur locking plate using Arbeitsgemeinschaft für Osteosynthesefragen techniques. At 3 months, iliac crest bone grafting, osteoperiosteal flaps, and augmented fixation with a medial locking plate were performed through a subvastus approach for a void in the medial supracondylar femur region. Intraoperatively, punctate bleeding was observed from the reimplanted fragment. Infection was ruled out with normal leukocyte count, C-reactive protein marker, no evidence of unhealthy granulation tissue, and a sterile culture report from the fracture site. The fracture healed in 12 months and the patient had good functional outcome with a lower extremity functional score of 80% and knee range of motion of 110° at short-term follow up of 2 years without any complication. Decision of reimplantation is individualized depending on the time of presentation, contamination, and comminution of extruded fragment with scarce literature on standard treatment strategies. In our case, early presentation, meticulous debridement, unique sterilization technique, immediate reimplantation, and augmented dual distal femur plating with bone grafting aided in achieving successful union with good functional outcome and knee range of motion, avoiding any complications.

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A novel technique for reimplanting extruded bone fragments in open fractures

Cited by 2 publications

References 12 publications

Managing bone loss in open fractures

Managing bone loss in open fractures

Successful sterilization and immediate reimplantation of extruded femoral diaphyseal segment: A case report and review of literature

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