Introduction Patients with open fracture Gustillo-Anderson grade 3 had undergone several surgical procedures, but still ended up with expose long dead bone or infected. Illizarov method was used to address long bone and soft tissue defect after re-debridement with radical resection of long dead bone or infected segment. Methods We included 14 patients (mean age: 30.86 ± 11.49) with non-union tibial fracture with long dead and infected bone segment who had undergone several debridement, bone grafting or spacer and soft tissue closure procedure due to open fracture of tibia grade 3. The subjects underwent re-debridement with radical resection of dead or infected bone segment followed by Illizarov method to perform bone transport procedure for bone defect filling and simultaneously restore severe soft tissue loss and bone lengthening procedure. Results All subjects had achieved satisfactory results with mean docking period of bone transport 3.78 ± 0.54 months, union time at the docking side 7 (5.5–9) months. Soft tissue was covered and no recurrence of infection. Three subjects had Leg Length Discrepancy (LLD) of 1 cm, whereas the remaining had zero discrepancy. No significant pain was observed at final follow-up and 4 patients had ankle joint stiffness. Conclusion The Illizarov method can effectively address long bone and soft tissue defects by distraction osteogenesis through bone transport procedure that filling the defect gradually without bone graft and simultaneously enhancing soft tissue closure without tertiary soft tissue procedure subsequently followed with bone lengthening procedure to correct the limb length discrepancy.

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Introduction. The main objective of hemiarthroplasty is to restore the shoulder into the state of fully functional and pain-free. The most important steps in performing hemiarthroplasty are during obtaining proper head height and shaft length, retroversion correction, and tuberosities fixation. Literatures have shown significant improvement on patients performed shoulder hemiarthroplasty, either in the short and medium term or in the long term.Methods. We did a retrospective cohort on patients with neglected proximal humerus fracture who underwent shoulder hemiarthroplasty at several hospitals in Jakarta, including Fatmawati general hospital, Siaga Raya hospital, Siloam hospital and Mitra Kemayoran hospital. Patients who underwent surgery within 2015 to 2018 were enrolled in this study. All patients with neglected Neer 3-part or Neer 4-part proximal humerus fracture, confirmed by x-ray and computed tomography scans, were included. Patients were referred to the surgeon at least 2 weeks after injuryResult. Hemiarthroplasty result in satisfactory functional outcomes, with ASES score Preoperative (median (range)) 4.9 (5-37) improved to Postoperative (Mean±SD) 67.27 ± 13.37. Despite the Age at surgery (years, Mean±SD) 63.87 ± 14.65 are in the elderly group and timing of the operation relative to the initial trauma is (median, range) 13 weeks (2-156), hemiarthroplasty still result in a satisfactory functional outcome even though our patients fracture pattern were Neer 3 and Neer 4.Conclusion. Hemiarthroplasty in neglected three- and four- part proximal humerus fracture is positively correlated with satisfactory clinical and functional outcomes even with associated AVN of humeral head despite the age and the timing of operation.