Emergency ectopic embedment of a large extruded bone mass for open lower limb bone defects / 中华创伤骨科杂志

ABSTRACT

Objective:To explore the efficacy of emergency ectopic embedment of a large extruded bone mass in the treatment of open lower limb bone defects.Methods:From June 2015 to June 2019, 11 patients were treated for open lower limb bone defects at Department of Traumatic Orthopedics & Microsurgery, Renmin Hospital of Wuhan University by primary ectopic embedment of a large extruded bone mass. They were 8 males and 3 females, aged from 18 to 57 years (mean, 35.3 years). The time from injury to operation ranged from 4 to 12 hours (mean, 6.3 hours). The size of free bone mass ranged from 3 to 16 cm (mean, 8.7 cm). At the emergency primary stage, following vascular and nerve anastomosis, large extruded bone masses were embedded ectopically to the sites with rich blood supply after cleaning and disinfection. The embedment was lateral to the thigh in 9 cases and in the groin in 2 cases. Wound repair was performed at the second stage, and bone replantation at the third stage, followed by internal plate fixation in 6 cases and external fixation in 5 cases. Fracture union was evaluated by regular X-ray follow-ups. At the last follow-up, Paley score was used to evaluate the curative outcomes, SF-36 score to evaluate functional recovery, and complications were recorded.Results:All patients were followed up for 6 to 50 months (mean, 15.5 months). Follow-ups observed no osteomyelitis. Fracture union was delayed in the 2 cases with external fixation but eventually achieved after bone graft and internal fixation. All fractures united after 5 to 12 months (mean, 8.5 months). The total treatment time ranged from 8 to 16 months (mean, 12.5 months). According to the Paley scores at the last follow-up, 7 cases were excellent, 3 good and one was poor, giving an excellent to good rate of 90.9% (10/11). The SF-36 scores for the postoperative quality of life averaged 86.7.Conclusion:Emergency ectopic embedment of a large extruded bone mass is a feasible treatment for open lower limb bone defects, with advantages of simplicity in operation and a low incidence of osteomyelitis.