The Results of 39 Fractures Complicated by Major Segmental Bone Loss and/or Leg Length Discrepancy

Abstract

Fractures (39) with segmental bone loss and/or limb length discrepancy with defects of 1.8-12.0 cm were reviewed retrospectively. Most patients presented with an acute open fracture with segmental bone loss or a late reconstructive problem with a nonunion, frequently complicated by infection, segmental bone loss and adjacent soft-tissue disruption. The average length of time of treatment before referral of a patient was 142 wk. Of the referred patients, 88% received a bone graft that included autologous cancellous bone, bank bone, a vascularized free iliac crest or fibular transplant, or some combination of these materials. Of the patients, 40% required some type of soft-tissue coverage such as a split-thickness skin graft, myoplasty or a free vascularized flap. Of the cases, 79% achieved complete osseous and soft-tissue healing within an average of 49 wk. One patient underwent an above-knee amputation. Almost 80% of all of the patients healed to within 85% or better of anatomic length. A protocol for the management of osseous and soft-tissue defects is outlined which includes debridement, rigid stabilization, and various types of soft-tissue and osseous reconstruction.