Skip to main content
SpringerLink
Log in

Reconstructive Strategies for Skeletal Complications in the Polytrauma Patient

  • Chapter
  • First Online:
The Poly-Traumatized Patient with Fractures

Abstract

Care of severe musculoskeletal injury in the polytrauma patient presents unique challenges. Host physiology and the local injury environment must be considered when performing initial management. Temporizing or staged care is often prudent yet when possible acute total care is employed. Despite appropriate initial management, these high energy injuries are prone to nonunion, residual deformity, and infection. Thoughtful late, often innovative, reconstructive efforts are often necessary to promote improved functionality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Pape HC, Tornetta 3rd P, Tarkin I, Tzioupis C, Sabeson V, Olson SA. Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg. 2009;17(9):541–9.

    PubMed  Google Scholar 

  2. Tarkin IS, Siska PA, Zelle BA. Soft tissue and biomechanical challenges encountered with the management of distal tibia nonunions. Orthop Clin North Am. 2010;41(1):119–26.

    Article  PubMed  Google Scholar 

  3. Tarkin IS, Sop A, Pape HC. High-energy foot and ankle trauma: principles for formulating an individualized care plan. Foot Ankle Clin. 2008;13(4):705–23.

    Article  PubMed  Google Scholar 

  4. Tarkin IS, Clare MP, Marcantonio A, Pape HC. An update on the management of high-energy pilon fractures. Injury. 2008;39(2):142–54.

    Article  PubMed  CAS  Google Scholar 

  5. Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117(7 Suppl):261S–93.

    Article  PubMed  CAS  Google Scholar 

  6. Arany L, Baranyai T, Mândi A, Kunkli F. Arteriographic studies in delayed-union and non-union of fractures. Radiol Diagn (Berl). 1980;21(5):673–81.

    CAS  Google Scholar 

  7. Dickson K, Katzman S, Delgado E, Contreras D. Delayed unions and nonunions of open tibial fractures. Correlation with arteriography results. Clin Orthop Relat Res. 1994;302:189–93.

    PubMed  Google Scholar 

  8. LeBus GF, Collinge C. Vascular abnormalities as assessed with CT angiography in high-energy tibial plafond fractures. J Orthop Trauma. 2008;22(1):16–22.

    Article  PubMed  Google Scholar 

  9. Pape HC, Tsukamoto T, Kobbe P, Tarkin I, Katsoulis S, Peitzman A. Assessment of the clinical course with inflammatory parameters. Injury. 2007;38(12):1358–64.

    Article  PubMed  Google Scholar 

  10. Biffl WL, Moore EE, Haenel JB. Nutrition support of the trauma patient. Nutrition. 2002;18:960–5.

    Article  PubMed  Google Scholar 

  11. Giannoudis PV, Pountos I, Morley J, Perry S, Tarkin IS, Pape HC. Growth factor release following femoral nailing. Bone. 2008;42(4):751–7.

    Article  PubMed  CAS  Google Scholar 

  12. Borrelli Jr J, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002;16(10):691–5.

    Article  PubMed  Google Scholar 

  13. Harwood PJ, Giannoudis PV, Probst C, Krettek C, Pape HC. The risk of local infective complications after damage control procedures for femoral shaft fracture. J Orthop Trauma. 2006;20:181–9.

    PubMed  Google Scholar 

  14. Carpenter CA, Jupiter JB. Blade plate reconstruction of metaphyseal nonunion of the tibia. Clin Orthop Relat Res. 1996;332:23–8.

    Article  PubMed  Google Scholar 

  15. Chin KR, Nagarkatti DG, Miranda MA, Santoro VM, Baumgaertner MR, Jupiter JB. Salvage of distal tibia metaphyseal nonunions with the 90 degrees cannulated blade plate. Clin Orthop Relat Res. 2003;409:241–9.

    Article  PubMed  Google Scholar 

  16. Sheerin DV, Turen CH, Nascone JW. Reconstruction of distal tibia fractures using a posterolateral approach and a blade plate. J Orthop Trauma. 2006;20(4):247–52.

    Article  PubMed  Google Scholar 

  17. Reed LK, Mormino MA. Functional outcome after blade plate reconstruction of distal tibia metaphyseal nonunions: a study of 11 cases. J Orthop Trauma. 2004;18(2):81–6.

    Article  PubMed  Google Scholar 

  18. Henry SL, Ostermann PA, Seligson D. The antibiotic bead pouch technique. The management of severe compound fractures. Clin Orthop Relat Res. 1993;295:54–62.

    PubMed  Google Scholar 

  19. Pelissier P, Martin D, Baudet J, Lepreux S, Masquelet AC. Behaviour of cancellous bone graft placed in induced membranes. Br J Plast Surg. 2002;55(7):596–8.

    Article  PubMed  Google Scholar 

  20. Ristiniemi J, Lakovaara M, Flinkkilä T, Jalovaara P. Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss: 22 of 23 fractures healed after 5–20 months. Acta Orthop. 2007;78(4):520–7.

    Article  PubMed  Google Scholar 

  21. Pelissier P, Masquelet AC, Bareille R, Pelissier SM, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res. 2004;22(1):73–9.

    Article  PubMed  CAS  Google Scholar 

  22. Brinker MR, O’Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma. 2007;21(8):557–70.

    Article  PubMed  Google Scholar 

  23. Perry M. Erythrocyte sedimentation rate and C reactive protein in the assessment of suspected bone infection – are they reliable indices? J R Coll Surg Edinb. 1996;41(2):116–8.

    PubMed  CAS  Google Scholar 

  24. Stucken C, et al. The preoperative diagnosis of infection in nonunions. OTA Annual Meeting, San Diego, CA 2009.

    Google Scholar 

  25. Johnson EE, Urist MR, Finerman GA. Distal metaphyseal tibial nonunion. Deformity and bone loss treated by open reduction, internal fixation, and human bone morphogenetic protein (hBMP). Clin Orthop Relat Res. 1990;250:234–40.

    PubMed  Google Scholar 

  26. Giannoudis PV, Kanakaris NK, Dimitriou R, Gill I, Kolimarala V, Montgomery RJ. The synergistic effect of autograft and BMP-7 in the treatment of atrophic nonunions. Clin Orthop Relat Res. 2009;467(12):3239–48.

    Article  PubMed  Google Scholar 

  27. Jones AL, Bucholz RW, Bosse MJ, Mirza SK, Lyon TR, Webb LX, et al. BMP-2 Evaluation in Surgery for Tibial Trauma-Allgraft (BESTT-ALL) study group. Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects. A randomized, controlled trial. J Bone Joint Surg Am. 2006;88(7):1431–41.

    Article  PubMed  Google Scholar 

  28. Dahabreh Z, Calori GM, Kanakaris NK, Nikolaou VS, Giannoudis PV. A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7. Int Orthop. 2008;33(5):1407–14.

    Article  PubMed  Google Scholar 

  29. Meister K, Segal D, Whitelaw GP. The role of bone grafting in the treatment of delayed unions and nonunions of the tibia. Orthop Rev. 1990;19(3):260–71.

    PubMed  CAS  Google Scholar 

  30. Kobbe P, Tarkin IS, Pape HC. Use of the ‘reamer irrigator aspirator’ system for non-infected tibial non-union after failed iliac crest grafting. Injury. 2008;39(7):796–800.

    Article  PubMed  Google Scholar 

  31. Kobbe P, Tarkin IS, Frink M, Pape HC. [Voluminous bone graft harvesting of the femoral marrow cavity for autologous transplantation. An indication for the“Reamer-Irrigator-Aspirator-” (RIA-)technique]. Unfallchirurg. 2008;111(6):469–72.

    Article  PubMed  CAS  Google Scholar 

  32. Quintero AJ, Tarkin IS, Pape HC. Technical tricks when using the reamer irrigator aspirator technique for autologous bone graft harvesting. J Orthop Trauma. 2010;24(1):42–5.

    Article  PubMed  Google Scholar 

  33. Chapman MW, Finkemeier CG. Treatment of supracondylar nonunions of the femur with plate fixation and bone graft. J Bone Joint Surg Am. 1999;81(9):1217–28.

    PubMed  CAS  Google Scholar 

  34. Richmond J, Colleran K, Borens O, Kloen P, Helfet DL. Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma. 2004;18(9):603–10.

    Article  PubMed  Google Scholar 

  35. Rosson JW, Simonis RB. Locked nailing for nonunion of the tibia. J Bone Joint Surg Br. 1992;74(3):358–61.

    PubMed  CAS  Google Scholar 

  36. Court-Brown CM et al. Locked intramedullary nailing of open tibial fractures. J Bone Joint Surg Br. 1991;73(6):959–64.

    PubMed  CAS  Google Scholar 

  37. Zelle BA, Gruen GS, Klatt B, Haemmerle MJ, Rosenblum WJ, Prayson MJ. Exchange reamed nailing for aseptic nonunion of the tibia. J Trauma. 2004;57(5):1053–9.

    Article  PubMed  Google Scholar 

  38. Court-Brown CM, Keating JF, Christie J, McQueen MM. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg Br. 1995;77-B(3):407–11.

    Google Scholar 

  39. Hak DJ, Lee SS, Goulet JA. Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma. 2000;14(3):178–82.

    Article  PubMed  CAS  Google Scholar 

  40. Nadkarni B, Srivastav S, Mittal V, Agarwal S. Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma. 2008;65(2):482–6.

    Article  PubMed  Google Scholar 

  41. Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-Chabock H. Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing. Orthopedics. 2009;32(6):409.

    Article  PubMed  Google Scholar 

  42. Tarkin IS Sojka JM. Biomechanical strategies for managing atrophic and oligotrophic nonunions. Oper Tech Orthop. 2008;18(2):86–94.

    Article  Google Scholar 

  43. Ring D, Jupiter JB, Gan BS, Israeli R, Yaremchuk MJ. Infected nonunion of the tibia. Clin Orthop Relat Res. 1999;369:302–11.

    Article  PubMed  Google Scholar 

  44. Struijs PA, Poolman RW, Bhandari M. Infected nonunion of the long bones. J Orthop Trauma. 2007;21(7):507–11.

    Article  PubMed  Google Scholar 

  45. Shahcheraghi GH, Bayatpoor A. Infected tibial nonunion. Can J Surg. 1994;37(3):209–13.

    PubMed  CAS  Google Scholar 

  46. Zelle BA, Gruen GS, Espiritu M, Pape HC. Posterior blade plate fusion: a salvage procedure in severe posttraumatic osteoarthritis of the tibiotalar joint. Oper Tech Orthop. 2006;16:68–75.

    Article  Google Scholar 

  47. Flemister Jr AS, Infante AF, Sanders RW, Walling AK. Subtalar arthrodesis for complications of intra-articular calcaneal fractures. Foot Ankle Int. 2000;21(5):392–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Kaufmann Building, Suite 1011, Pittsburgh, PA, 15213, USA

    Steven Sands, Peter A. Siska & Ivan S. Tarkin

Authors
  1. Steven Sands
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter A. Siska
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ivan S. Tarkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivan S. Tarkin .

Editor information

Editors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinikum Aachen, Pauwelsstraße 30, Aachen, 52057, Germany

    Hans-Christoph Pape

  2. Florida Orthopaedic Institute, N. Telecom Parkway 13020, Temple Terrace, 33637, Florida, USA

    Roy Sanders

  3. Southwestern Medical Center at Dallas, University of Texas, Harry Hines Blvd. 5323, Dallas, 75390, Texas, USA

    Joseph Borrelli, Jr.

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Sands, S., Siska, P.A., Tarkin, I.S. (2011). Reconstructive Strategies for Skeletal Complications in the Polytrauma Patient. In: Pape, HC., Sanders, R., Borrelli, Jr., J. (eds) The Poly-Traumatized Patient with Fractures. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-17986-0_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-17986-0_27

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-17985-3

  • Online ISBN: 978-3-642-17986-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation