A novel technique for reimplanting extruded bone fragments in open fractures

Extruded bone fragments are a rare complication of high-energy open fractures. Generally, management is thorough debridement and managing the bone defect. In the literature, there are only a few case reports where successful retention of the free bone fragment has been done. Disinfection of bone fra...

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Main Authors: Sameer Rathore, Indukuri Viswanatha Reddy, A.H. Ashwin Kumar
Format: Article
Language:English
Published: Elsevier 2016-06-01
Series:Trauma Case Reports
Online Access:http://www.sciencedirect.com/science/article/pii/S2352644016300103
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spelling doaj-338106467ed0438885b7095e4f68c9c02020-11-24T23:41:00ZengElsevierTrauma Case Reports2352-64402016-06-014511A novel technique for reimplanting extruded bone fragments in open fracturesSameer Rathore0Indukuri Viswanatha Reddy1A.H. Ashwin Kumar2Corresponding author. Tel.: +91 8989457001, +91 9573007744; fax: +91 040 27840980.; Department of Orthopaedics, Block 3, 3rd Floor, Krishna Institute of Medical Sciences, Secunderabad 500003, IndiaDepartment of Orthopaedics, Block 3, 3rd Floor, Krishna Institute of Medical Sciences, Secunderabad 500003, IndiaDepartment of Orthopaedics, Block 3, 3rd Floor, Krishna Institute of Medical Sciences, Secunderabad 500003, IndiaExtruded bone fragments are a rare complication of high-energy open fractures. Generally, management is thorough debridement and managing the bone defect. In the literature, there are only a few case reports where successful retention of the free bone fragment has been done. Disinfection of bone fragment is done by autoclaving or use of antiseptic/antibiotic solution. Autoclaving leads to complete loss of viable cells and antiseptic/antibiotic solutions do not disinfect completely. In this case report, authors present an innovative technique of disinfecting the bone fragment effectively with minimum compromise on biology.A 38-year-old male with compound grade III B comminuted fracture of distal femur with 2 extruding bone pieces was managed by thorough debridement, external fixator and antibiotic cement spacer. The extruded bone fragments were rinsed in saline and diluted betadine and implanted in subfascial plane in healthy soft tissues in the thigh along with a few antibiotic beads for assuring disinfection. After 1 week, when no clinical signs of infection were found, the site was opened, cement spacer removed, free fragments positioned anatomically and rigid internal fixation was done. Fracture united at 6 months with good functional outcome. At last follow-up at 1 year, the patient was mobilising freely and there were no signs of low grade infection.The key points of this procedure are: 1) Viability of bone fragment maintained while achieving disinfection. 2) Traumatised soft tissues healed and prepared for accepting the free bone fragment. 3) Use of antibiotic cement counters any remaining chances of infection after thorough debridement. 4) Faster union with maintenance of bone length and alignment with use of anatomic fragments.Extensive search of literature was done and this procedure was found to be novel. A larger case series can help in determining the utility of this technique in compound fractures. Keywords: Open fractures, Bone loss, Extruded bone fragments, Reimplantation of extruded bone fragments, Management of bone losshttp://www.sciencedirect.com/science/article/pii/S2352644016300103
collection DOAJ
language English
format Article
sources DOAJ
author Sameer Rathore
Indukuri Viswanatha Reddy
A.H. Ashwin Kumar
spellingShingle Sameer Rathore
Indukuri Viswanatha Reddy
A.H. Ashwin Kumar
A novel technique for reimplanting extruded bone fragments in open fractures
Trauma Case Reports
author_facet Sameer Rathore
Indukuri Viswanatha Reddy
A.H. Ashwin Kumar
author_sort Sameer Rathore
title A novel technique for reimplanting extruded bone fragments in open fractures
title_short A novel technique for reimplanting extruded bone fragments in open fractures
title_full A novel technique for reimplanting extruded bone fragments in open fractures
title_fullStr A novel technique for reimplanting extruded bone fragments in open fractures
title_full_unstemmed A novel technique for reimplanting extruded bone fragments in open fractures
title_sort novel technique for reimplanting extruded bone fragments in open fractures
publisher Elsevier
series Trauma Case Reports
issn 2352-6440
publishDate 2016-06-01
description Extruded bone fragments are a rare complication of high-energy open fractures. Generally, management is thorough debridement and managing the bone defect. In the literature, there are only a few case reports where successful retention of the free bone fragment has been done. Disinfection of bone fragment is done by autoclaving or use of antiseptic/antibiotic solution. Autoclaving leads to complete loss of viable cells and antiseptic/antibiotic solutions do not disinfect completely. In this case report, authors present an innovative technique of disinfecting the bone fragment effectively with minimum compromise on biology.A 38-year-old male with compound grade III B comminuted fracture of distal femur with 2 extruding bone pieces was managed by thorough debridement, external fixator and antibiotic cement spacer. The extruded bone fragments were rinsed in saline and diluted betadine and implanted in subfascial plane in healthy soft tissues in the thigh along with a few antibiotic beads for assuring disinfection. After 1 week, when no clinical signs of infection were found, the site was opened, cement spacer removed, free fragments positioned anatomically and rigid internal fixation was done. Fracture united at 6 months with good functional outcome. At last follow-up at 1 year, the patient was mobilising freely and there were no signs of low grade infection.The key points of this procedure are: 1) Viability of bone fragment maintained while achieving disinfection. 2) Traumatised soft tissues healed and prepared for accepting the free bone fragment. 3) Use of antibiotic cement counters any remaining chances of infection after thorough debridement. 4) Faster union with maintenance of bone length and alignment with use of anatomic fragments.Extensive search of literature was done and this procedure was found to be novel. A larger case series can help in determining the utility of this technique in compound fractures. Keywords: Open fractures, Bone loss, Extruded bone fragments, Reimplantation of extruded bone fragments, Management of bone loss
url http://www.sciencedirect.com/science/article/pii/S2352644016300103
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