Open Diaphyseal Long Bone Fractures: A Reduction Method Using Devitalized or Extruded Osseous Fragments

Abstract

Open diaphyseal and meta-diaphyseal fractures of the lower extremity remain therapeutically challenging. Currently accepted treatment methods consist of a thorough irrigation and debridement of nonviable tissue combined with locked intramedullary nailing. Although exact reduction parameters remain controversial, achievement of a satisfactory reduction becomes increasingly difficult with fracture comminution and overt bone loss. We describe the simple technique of using multiple associated devitalized tibial bone fragments to obtain an accurate reduction prior to intramedullary nailing. This technique can be extended to other long bone fractures.

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

“…1 Kirkup was the first to report on the reimplantation of extruded femoral bone fragment. 18 Large-free fragments have been used to achieve an anatomic reduction in reimplantation surgeries, as advocated by Barei et al 19 Since then, several authors have described their experiences with different sterilizing techniques like boiling, autoclaving, gamma irradiation, and soaking with 2% and 4% chlorhexidine, 10% povidone-iodine solution and antibiotic solution. However, there is no universal treatment strategy and method of sterilization for reimplantation.…”

Current Perspectives on the Management of Bone Fragments in Open Tibial Fractures: New Developments and Future Directions

“…Lastly, it is important to mention that definitive re-incorporation of devitalised bone fragments may not always be appropriatehowever temporary re-incorporation may be beneficial as a technique to help obtain a more anatomic reduction of the fracture during the definitive fixation procedure. 103 …”

Complex Tibial Fractures: Tips and Tricks for Intramedullary Nail Fixation

“…In the case of an open fracture with extruded or devitalized segments, Nork has described using these segments as a reduction aid rather than immediately discarding them as the traditional principles of open fracture treatment might dictate. 21 Alternatively, these segments can be soaked in chlorhexadine solution and used as a template to guide reduction, either by clamping or provisional plate fixation. Once the nailing procedure has been completed the devitalized fragments can then be discarded.…”