创伤与治疗杂志

To Put Back in the Body or to Drop in the Bucket- Outcome after Using an Extruded Devitalized Segment of Bone in an Open Distal Femoral Fracture

Abstract

Mohamad Gouse, Subin Babu, Ravichand Ismavel and Korulla Mani Jacob

A segmental bone defect caused by an open fracture is a daunting problem to deal with and the traditional treatment options that are currently practiced to treat such conditions include allo or autologous bone graft, distraction osteogenesis and membrane induction. Infrequently the course of treatment is complicated by non-union and infection, thus requiring multiple staged procedures that may affect the functional outcome. We present a case of a 25 year old gentleman who had sustained an isolated open type III A comminuted distal femur fracture with a part of the diaphyseal distal femur extruding from the body with no soft tissue attached. His plain radiograph showed comminuted distal femur AO C3 fracture. Following debridement, the extruding diaphyseal fragment was washed and cleaned with normal saline and retained inside the body. The limb was stabilized with an external fixator and 48 hours later he was taken for a second debridement wherein a stable internal fixation was done retaining the extruded fragment. Post operatively he recovered well without wound complications or any deep or superficial infection. The follow up radiographs showed that the bone coalesced with an uneventful union and in next 3 years the knee ROM was 0-130 degrees. His lower extremity functional score was (LEFS) 74. This case is to highlight the importance of judicious insight at times when debridement is the matter of concern, taking into consideration that all reconstructive options are available. The outcome of other staged reconstructive procedures to bridge such bone loss is far more tedious and sure to have a far less efficacious outcome than what has been described here. This report also described about other literature about the option available for such condition.