In the event of a severe high energy injury to a limb or following a severe soft tissue and bone infection, patients may be in a situation where bone has to be removed due to it being so badly damaged, with no blood supply and confirmed infection or a high risk of infection if left in place.
This creates a unique clinical problem of how to fill the bone defect.
The size of the bone defect relative to the overall length of the bone is an important consideration.
A segment of bone loss of 2cm in the femur (thighbone) and of 2cm loss of bone in the finger both present their own challenges.
The team at OTL have experience in the management of bone defects and the following options are the treatments used:
- Acute shortening
- Bone grafting
- Masquelet technique
- Distraction osteogenesis
In acute shortening the bone defect is relatively small, and the two ends of the residual bone can be docked acutely and the fracture stabilised.
Bone grafting is used for larger defects. The options for bone graft include bone graft harvested from the patient (autograft), bone graft from another person from a registered company or bone graft (allograft) and synthetic graft.
The Masquelet technique is used for large bone defects
Distraction osteogenesis is also used for large bone defects and is the process of bone transport - where a segment of bone is transported to fill in the defect. As it is transported at a specific rate new bone will form in the tract behind it. Distraction osteogenesis is commonly performed with a circular frame but there has been very good reports with the use of magnetic intrameduillry lengthening nails (PRECICE).