title: The results of 39 fractures complicated by major segmental bone loss and/or leg length discrepancy.
abstract: Thirty-nine fractures with segmental bone loss and/or limb length discrepancy with defects of 1.8 to 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. One hundred forty-two weeks was the average length of time of treatment before referral of a patient to us. Eighty-eight per cent of the patients received a bone graft that included either autologous cancellous bone, bank bone, a vascularized free iliac crest or fibular transplant, or some combination of these materials. Forty per cent of the patients required some type of soft-tissue coverage such as a split-thickness skin graft, myoplasty, or a free vascularized flap. Seventy-nine per cent of the cases achieved complete osseous and soft-tissue healing within an average of 49 weeks. One patient underwent an above-knee amputation. Almost 80% of all of the patients healed to within 85% or better of anatomic length. Based upon these results 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.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001852:Bone Lengthening; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005592:Fracture Fixation; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications / Q000628:therapy*; D005599:Fractures, Ununited / Q000628:therapy; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014946:Wound Infection / Q000209:etiology / Q000628:therapy