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Definitive Surgery for Open Fractures of the Long Bones with External Fixatıon

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Basic Techniques for Extremity Reconstruction

Abstract

Reconstruction Methods for Fractures with Bone Defects, Vascular Injury, and Salvage Procedures

Management of severely injured extremities remains challenging for orthopedic surgeons. They are associated with higher rates of limb loss in addition to high mortality, secondary amputation, nonunion, infection, multiple surgical interventions, occupational changes, and psychological problems. Patients with high-energy open extremity fractures and massive soft tissue damage pose a demanding clinical challenge that requires a complex interdisciplinary approach and multiple orthopedic, vascular, and reconstructive procedures. Developments in orthopedic fixation, vascular, and soft tissue repair have allowed more severely injured limbs to be salvaged over the last two decades. At the time of emergency presentation, an immediate decision is required regarding limb salvage versus amputation. Various scoring systems using a variety of components have been developed to assist surgeons in making a decision. Open long bone fractures with vascular injury that need vascular reconstruction are classified as Grade 3C open fractures according to the Gustilo-Anderson classification system.

Reconstruction Methods for Fractures wıth Soft Tissue Defects: Acute Angulation Technique

High-energy traumas are always a challenging orthopedic problem. Besides the multi-fragmentation of the bone in high-energy trauma, disruption of the soft tissue coverage makes treatment difficult. The Ilizarov external fixator, which is often used in the treatment of these injuries, is a successful method.

IM Nailing with Cage Technique

Bone defects are frequently encountered in routine orthopedic practice. Surgery, in cases of open fractures, infection, and nonunion, may be complicated by bone loss. Segment transport with external fixators is still the gold standard. Regenerating bone by distraction osteogenesis provides biologic healing of the bone while preserving its original architecture. However, the average time to obtain new load-bearing bone is one and a half months for each centimeter, and the treatment may take quite a long time because the size of the defect increases. Complications encountered throughout the treatment period are numerous and increase with the time spent in the external fixator. Vascularized bone transfers, massive allografts, and metallic implants are other alternative methods of reconstruction, but each method has its own limitations, and orthopedic surgeons still seek new approaches with less patient morbidity. Cylindrical titanium mesh cages for bone defects of the appendicular skeleton have been adopted from postvertebrectomy reconstruction. Hollow titanium mesh cages have been used with success for reconstruction of the corpectomy defects of the vertebra. The first report on the use of titanium mesh cages for the treatment of defective, open fractures of the tibia was published by Cobos et al. in 2002. Since then there have been few additional case reports, and the literature lacks case series with long-term follow-up. The indications, surgical technique, and possible complications will be discussed in this chapter.

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Reconstruction Methods for Fractures with Bone Defects, Vascular Injury, and Salvage Procedures

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Authors and Affiliations

  1. Istanbul Faculty of Medicine, Orthopaedic and Traumatology Department, Istanbul University, 34190, Istanbul, Turkey

    Cengiz Şen MD & Halil Ibrahim Balci MD, FEBOT

  2. Ortopedia Hospital, Adana, Turkey

    Mustafa Celiktaş MD & Mahir Gulsen MD

  3. Orthopaedic and Traumatology Department, Cukurova University, Adana, Turkey

    Cenk Ozkan MD

Authors
  1. Cengiz Şen MD
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  2. Halil Ibrahim Balci MD, FEBOT
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  3. Mustafa Celiktaş MD
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  4. Cenk Ozkan MD
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  5. Mahir Gulsen MD
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Corresponding authors

Correspondence to Halil Ibrahim Balci MD, FEBOT or Cengiz Şen and MD .

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Editors and Affiliations

  1. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Mehmet Çakmak

  2. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Cengiz Şen

  3. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Levent Eralp

  4. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Halil Ibrahim Balci

  5. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Melih Civan

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Şen, C., Balci, H.I., Celiktaş, M., Ozkan, C., Gulsen, M. (2018). Definitive Surgery for Open Fractures of the Long Bones with External Fixatıon. In: Çakmak, M., Şen, C., Eralp, L., Balci, H., Civan, M. (eds) Basic Techniques for Extremity Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-45675-1_9

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