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. 2020 Mar 23;3(1):e059.
doi: 10.1097/OI9.0000000000000059. eCollection 2020 Mar.

Managing bone loss in open fractures

Andrew Adamczyk  1 , Bradley Meulenkamp  1 , Geoffrey Wilken  1 , Steven Papp  1
Affiliations

Managing bone loss in open fractures

Andrew Adamczyk et al. OTA Int. .

Abstract

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.

Keywords: bone loss; lower extremity fracture; open fracture.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Defining the lower limit of a “Critical Bone Defect” in open diaphyseal tibial fractures. (Taken from Haines NM, Lack WD, Seymour RB, and Bosse MJ. Defining the lower limit of a “Critical bone defect” in open diaphyseal tibial fractures. J Orthop Trauma 30, e158–e163 (2016).)
Figure 2
Figure 2
(A) AP, (B) lateral left femur (C) AP pelvis, and (D) Iateral left hip 3 weeks postop from irrigation and debridement, with open reduction internal fixation of distal femur, short InterTan and first stage Masquelet technique at an outside tertiary care center.
Figure 3
Figure 3
(A) AP, (B) lateral left femur, and (C) AP left hip postoperative day 1 from second stage masquelet technique with fibullar strut allograft.
Figure 4
Figure 4
(A) AP and (B) lateral left femur 6 months postop, demonstrating maintenance of internal fixation stability, and good consolidation.
Figure 5
Figure 5
(A) AP and (B) lateral left femur 1 year postop, demonstrating maintenance of hardware fixation, and complete graft consolidation.
See this image and copyright information in PMC

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