Extruded bone fragments are a rare complication of high-energy open fractures. Generally, management is thorough debridement and managing the bone defect. In the literature, there are only a few case reports where successful retention of the free bone fragment has been done. Disinfection of bone fragment is done by autoclaving or use of antiseptic/antibiotic solution. Autoclaving leads to complete loss of viable cells and antiseptic/antibiotic solutions do not disinfect completely. In this case report, authors present an innovative technique of disinfecting the bone fragment effectively with minimum compromise on biology.A 38-year-old male with compound grade III B comminuted fracture of distal femur with 2 extruding bone pieces was managed by thorough debridement, external fixator and antibiotic cement spacer. The extruded bone fragments were rinsed in saline and diluted betadine and implanted in subfascial plane in healthy soft tissues in the thigh along with a few antibiotic beads for assuring disinfection. After 1 week, when no clinical signs of infection were found, the site was opened, cement spacer removed, free fragments positioned anatomically and rigid internal fixation was done. Fracture united at 6 months with good functional outcome. At last follow-up at 1 year, the patient was mobilising freely and there were no signs of low grade infection.The key points of this procedure are: class="simple" style="list-style-type:none" id="l0005">
1)Viability of bone fragment maintained while achieving disinfection.
2)Traumatised soft tissues healed and prepared for accepting the free bone fragment.
3)Use of antibiotic cement counters any remaining chances of infection after thorough debridement.
4)Faster union with maintenance of bone length and alignment with use of anatomic fragments.Extensive search of literature was done and this procedure was found to be novel. A larger case series can help in determining the utility of this technique in compound fractures.
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机译:挤压的骨碎片是高能开放性骨折的罕见并发症。通常,管理是彻底清创和管理骨缺损。在文献中,只有少数病例报告成功完成了游离骨碎片的保留。骨碎片的消毒可通过高压灭菌或使用杀菌剂/抗生素溶液进行。高压灭菌会导致活细胞完全丧失,并且防腐剂/抗生素溶液无法完全消毒。在本病例报告中,作者提出了一种有效的方法,以最小的生物学影响对骨碎片进行有效消毒。通过彻底清创术治疗了38岁男性,股骨远端复合B级粉碎性骨折并伴有2处挤出的骨块,外固定器和抗生素水泥垫片。将挤出的骨碎片用盐水冲洗,并稀释倍他定,然后与一些抗生素珠一起植入大腿健康软组织的筋膜下平面中,以确保消毒。 1周后,当未发现感染的临床迹象时,将部位打开,去除骨水泥垫片,将游离碎片解剖定位并进行牢固的内固定。骨折合并6个月,功能预后良好。在1年的最后一次随访中,患者自由活动,没有低度感染的迹象。此过程的关键点是: class =“ simple” style =“ list-style-type:none” id =“ l0005”> <!-list-behavior =简单的前缀-word = mark-type = none max-label-size = 2->