The management of fractures with bone loss

Outcome of distraction osteogenesis by ring fixator in infected, large bone defects of tibia

“…Goal of treatment in infected nonunion is to obtain solid bony union and eradication of infection with maximum functional use of the extremity. 1 The bone and functional results in the present study were comparable to those reported in literature (Tables 2 and 3). 5,6,8,13,14 A thorough debridement to vascularized, living tissue seems necessary, even when using Ilizarov technique to repair the bony portion of nonunion.…”

“…Some of the bony reconstruction procedures include open cancellous bone grafting, posterior bone grafting with tibiofibular synostosis, anterior cancellous bone graft beneath a flap, vascularized or nonvascularized transfer of ipsilateral fibula into the tibia, nonvascular autogenous cortical bone grafts, transplant of allograft bone, and distraction histiogenesis. [1][2][3] However, options for bony defects 6 cm or more in tibia are limited. The present prospective study reports outcome of ring fixator in infected, large (≥6 cm) bone defects of tibia treated with distraction osteogenesis.…”

“…are described to treat infected nonunions. [1][2][3][4][5][6] Fractures with ≥6 cm bone defect require individualized Results: Fracture united primarily in 17 cases and after fixator adjustment with freshening of fracture margins in 15 cases. Fixator adjustment with bone grafting was done in one patient to achieve union.…”

“…26 Circular frames are more popular than uniaxial devices since they confer greater stability and more flexibility in the configuration of the frame. 1 Attempting limb reconstruction in the presence of significant bone loss usually involves surgery which is technically difficult, time consuming, physically and psychologically demanding for the patient, and with no guarantee of a satisfactory outcome. 1 The dilemma faced by the treating surgeon is to decide when to opt for amputation and prosthetic replacement over salvage.…”

Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss

“…Segmental bone loss exceeding 4 to 6 cm has been considered unsuitable for cancellous bone grafting in some reviews (Decoster et al 2004, Keating et al 2005. There have been a few small series, however, in which tibial bone loss up to 25 cm in length has been treated successfully with cancellous bone grafting (Christian et al 1989, Watson et al 1995, Masquelet 2003, Schlötte et al 2005.…”