Management of Posttraumatic Segmental Bone Defects

Abstract Because of difficulty in managing posttraumatic segmental bone defects and the resultant poor outcomes, amputation historically was the preferred treatment. Massive cancellous bone autograft has been the principal alternative to amputation. Primary shortening or use of the adjacent fibula as a graft also has been used to attempt limb salvage. Of more recent methods of management, bone transport with distraction osteogenesis has been suggested as the leading option for defects of 2 to 10 cm, but problems include delayed union at the docking site and prolonged treatment time. Free vascularized bone transfer has been suggested as the leading option for defects of 5 to 12 cm, but hypertrophy of the graft is unreliable and late fracture, common. Bone graft substitutes continue to be developed, but they have not yet reached clinical efficacy for posttraumatic segmental bone defects. Although each of the new techniques has shown some limited success, complications remain common.

[1]  D. Clawson,et al.  Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. , 2005, The Journal of bone and joint surgery. American volume.

[2]  J. Mader,et al.  A Clinical Staging System for Adult Osteomyelitis , 2003, Clinical orthopaedics and related research.

[3]  H. Seeherman,et al.  Bone consolidation is enhanced by rhBMP‐2 in a rabbit model of distraction osteogenesis , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[4]  S D Cook,et al.  The Effect of Osteogenic Protein-1 on the Healing of Segmental Bone Defects Treated with Autograft or Allograft Bone , 2001, The Journal of bone and joint surgery. American volume.

[5]  M. Mccarthy,et al.  Short-Term Wound Complications After Application of Flaps for Coverage of Traumatic Soft-Tissue Defects About the Tibia* , 2000, The Journal of bone and joint surgery. American volume.

[6]  E. Chao,et al.  Distraction Osteogenesis After Acute Limb-Shortening for Segmental Tibial Defects: Comparison of a Monofocal and a Bifocal Technique in Rabbits* , 2000, The Journal of bone and joint surgery. American volume.

[7]  M. Bostrom,et al.  Biosynthetic bone grafting. , 1999, Clinical orthopaedics and related research.

[8]  G. Hofmann,et al.  Segment transport employing intramedullary devices in tibial bone defects following trauma and infection. , 1999, Journal of orthopaedic trauma.

[9]  A. Simpson,et al.  Biologic model of bone transport distraction osteogenesis and vascular response , 1999, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  G. Papachristou,et al.  Treatment of tibial and femoral bone loss by distraction osteogenesis. Experience in 28 infected and 14 clean cases. , 1997, Acta orthopaedica Scandinavica. Supplementum.

[11]  L. Weiner,et al.  Treatment of type II and type III open tibia fractures in children. , 1997, Journal of orthopaedic trauma.

[12]  J. Nunley,et al.  Treatment of Segmental Defects of the Radius with Use of the Vascularized Osteoseptocutaneous Fibular Autogenous Graft* , 1997, The Journal of bone and joint surgery. American volume.

[13]  R. Feibel,et al.  Combined Muscle Flap and Ilizarov Reconstruction for Bone and Soft Tissue Defects , 1996, Clinical orthopaedics and related research.

[14]  L. Dahners,et al.  The Mangled Extremity: When Should It Be Amputated? , 1996, The Journal of the American Academy of Orthopaedic Surgeons.

[15]  R. Esser.  Treatment of a bone defect of the forearm by bone transport. A case report. , 1996, Clinical orthopaedics and related research.

[16]  T. Vail,et al.  Donor-Site Morbidity with Use of Vascularized Autogenous Fibular Grafts* , 1996, The Journal of bone and joint surgery. American volume.

[17]  J. Watson.  Treatment of Tibial Fractures with Bone Loss , 1996 .

[18]  R. Jakob,et al.  Use of the ipsilateral vascularised fibula for tibial reconstruction. , 1995, The Journal of bone and joint surgery. British volume.

[19]  H. Schwartz,et al.  Structural Allografts for Reconstruction of Lower Extremity Open Fractures with 10 Centimeters or More of Acute Segmental Defects , 1995, Journal of orthopaedic trauma.

[20]  G. Dendrinos,et al.  Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. , 1995, The Journal of bone and joint surgery. American volume.

[21]  J. Watson,et al.  Management strategies for bone loss in tibial shaft fractures. , 1995, Clinical orthopaedics and related research.

[22]  J. L. Marsh,et al.  Segmental bone deficiency after acute trauma. The role of bone transport. , 1994, The Orthopedic clinics of North America.

[23]  M. Pirela-Cruz,et al.  Vascularized bone grafts. , 1994, Orthopedics.

[24]  M. Williams,et al.  Long-term cost comparison of major limb salvage using the Ilizarov method versus amputation. , 1994, Clinical orthopaedics and related research.

[25]  S. Green,et al.  Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects. , 1994, Clinical orthopaedics and related research.

[26]  J. L. Marsh,et al.  Chronic infected tibial nonunions with bone loss. Conventional techniques versus bone transport. , 1994, Clinical orthopaedics and related research.

[27]  G. Cierny,et al.  Segmental tibial defects. Comparing conventional and Ilizarov methodologies. , 1994, Clinical orthopaedics and related research.

[28]  A. Minami,et al.  Fracture Through United Vascularized Bone Grafts , 1993, Journal of reconstructive microsurgery.

[29]  A. Kreicbergs,et al.  Comparison of demineralized allogeneic bone matrix grafting (the Urist procedure) and the Ilizarov procedure in large diaphyseal defects in sheep , 1993, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[30]  A. Hutter,et al.  Reconstruction of the Lower Extremity after Grade III Distal Tibial Injuries Using Combined Microsurgical Free Tissue Transfer and Bone Transport by Distraction Osteosynthesis , 1993, Annals of plastic surgery.

[31]  David M. Wall,et al.  Management of segmental defects by the Ilizarov intercalary bone transport method. , 1992, Clinical orthopaedics and related research.

[32]  Ilizarov Ga,et al.  The Replacement of Long Tubular Bone Defects by Lengthening Distraction Osteotomy of One of the Fragments , 1992 .

[33]  A. Minami,et al.  Treatment of Infected Segmental Defect of Long Bone with Vascularized Bone Transfer , 1992, Journal of reconstructive microsurgery.

[34]  R. Gustilo,et al.  The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury. , 1991, The Journal of bone and joint surgery. American volume.

[35]  G. Robb,et al.  Reconstruction of large diaphyseal defects, without free fibular transfer, in Grade-IIIB tibial fractures. , 1989, The Journal of bone and joint surgery. American volume.

[36]  M. McAndrew,et al.  Vascularized autografts for reconstruction of skeletal defects following lower extremity trauma. A review. , 1989, Clinical orthopaedics and related research.

[37]  R. Brumback,et al.  Early prophylactic bone grafting of high-energy tibial fractures. , 1989, Clinical orthopaedics and related research.

[38]  G. Finerman,et al.  Repair of segmental defects of the tibia with cancellous bone grafts augmented with human bone morphogenetic protein. A preliminary report. , 1988, Clinical orthopaedics and related research.

[39]  T. Kristiansen,et al.  Noncommercial fabrication of antibiotic-impregnated polymethylmethacrylate beads. Technical note. , 1987, Clinical orthopaedics and related research.

[40]  P. Manson,et al.  Acute and Definitive Management of Traumatic Osteocutaneous Defects of the Lower Extremity , 1987, Plastic and reconstructive surgery.

[41]  R. Richards,et al.  The influence of muscle flap coverage on the repair of devascularized tibial cortex: an experimental investigation in the dog. , 1987, Plastic and reconstructive surgery.

[42]  A. Weiland,et al.  Clinical applications of vascularized bone autografts. , 1987, The Orthopedic clinics of North America.

[43]  R. Winquist.  Closed Intramedullary Osteotomies of the Femur , 1986, Clinical orthopaedics and related research.

[44]  D. Clawson,et al.  Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. 1984. , 1984, The Journal of bone and joint surgery. American volume.

[45]  A. Weiland,et al.  The efficacy of free tissue transfer in the treatment of osteomyelitis. , 1984, The Journal of bone and joint surgery. American volume.

[46]  A. Agiza,et al.  Treatment of tibial osteomyelitic defects and infected pseudarthroses by the Huntington fibular transference operation. , 1981, The Journal of bone and joint surgery. American volume.

[47]  W. Eversmann,et al.  The management of segmental bone loss associated with forearm fractures. , 1980, The Journal of bone and joint surgery. American volume.

[48]  Y. Floman,et al.  Early fibular bypass procedures (tibiofibular synostosis) for massive bone loss in war injuries. , 1979, The Journal of trauma.

[49]  M. Urist.  Bone: Formation by Autoinduction , 1965, Science.

[50]  P. Harmon.  A SIMPLIFIED SURGICAL APPROACH TO THE POSTERIOR TIBIA FOR BONE-GRAFTING AND FIBULAR TRANSFERENCE , 1945 .

[51]  T. W. Huntington.  CASE OF BONE TRANSFERENCE , 1905 .

[52]  Z. Gugala,et al.  The cylindrical titanium mesh cage for treatment of a long bone segmental defect: description of a new technique and report of two cases. , 2000, Journal of orthopaedic trauma.

[53]  L. Schweiberer,et al.  [Primary shortening--secondary lengthening. A new treatment concept for reconstruction of extensive soft tissue and bone injuries after 3rd degree open fracture and amputation of the lower leg]. , 1998, Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V....

[54]  D. Mears,et al.  The results of 39 fractures complicated by major segmental bone loss and/or leg length discrepancy. , 1984, The Journal of trauma.

[55]  A. Weiland.  Current concepts review: vascularized free bone transplants. , 1981, The Journal of bone and joint surgery. American volume.