Acute Shortening and re-lengthening in the management of open tibia fractures with severe bone of 14 CMS or more and extensive soft tissue loss.

INTRODUCTION: A traumatic event to the tibia with more than 14 cm of bone and soft tissue loss represents a challenge to most orthopedic surgeons and is considered a limb-threatening condition. Few solutions are available in such clinical situations and among them is the acute shortening and re-lengthening of bone and soft tissue. MATERIALS AND METHODS: Our study presents the management of 7 patients with grade III B open fractures (according to the Gustillo-Anderson classification) of the tibia who underwent resection of all the devitalized tissues, acute limb shortening to close the defect, application of an external fixator, and metaphyseal osteotomy for re-lengthening. The patient outcomes were based on different parameters using the evaluation system established by Paley et al. RESULTS: Results acquired during the study show an average bone loss of 19cm (with a minimum of 14 cm and a maximum of 31.50cm). The average time to full recovery of all patients was 19 months with a minimum of 14 months and a max of 34 months. Patient presented with excellent bony union and none existent or small refractory leg length discrepancy and did not require bone grafts or free flaps. Complications that the patients had were contractures, which required secondary procedures such as Achilles tendon re-lengthening and recurrent infections. DISCUSSION: Overall patients had excellent bone union and were able to perform activities of their daily living. The Ilizarov technique of compression-dis- traction osteogenesis is an elegant treatment option that should be considered in patients suffering such traumatic events providing excellent bony union and good functional outcomes for the patient.

THE USE OF A FIBULAR STRUT ALLOGRAFT WITH DBM, CANCELLOUS CHIPS AND BMP FOR A 10 CM HUMERAL SHAFT INFECTED NON-UNION: A CASE REPORT.

Humeral shaft non-unions occur in 2-10% of all fracture cases. Increased incidence of these non-unions can be associated with ORIF, comminution, high impact injuries, bone loss or fracture gaping. Treatment guidelines for fracture non-union state that fractures with gaps greater than 4 cm should be treated with vascularized fibular autografts or transportation with an external fixator. Unfortunately these modalities carry considerable donor site morbidity and patient will experience considerable discomfort, especially when dealing with an external fixator. This report demonstrates how the use of a nonvascularized fibular strut can be effectively utilized as an alternate treatment modality for large humeral shaft non-union gaps. Further studies should be conducted to support this method as a viable treatment option for non-union gaps greater than 4 cm.