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BONE DEFECTS CAUSED BY TRAUMA

All open fractures (where a broken bone has punctured the skin) are contaminated by exposure to the outside environment, and the more severe the soft tissue injury, the higher the risk of infection, non-union/failure to heal and amputation.

The objectives of surgical treatment are to prevent infection, achieve union/healing and restore function, for example good movement of the shoulder, or the ability to walk without crutches.

In closed or simple fractures that require open reduction internal fixation (ORIF), there are commonly four main complications, non-union/failure to heal, re-fracture, implant failure (i.e. failure of metalwork such as broken or bent plates or screws) and infection. The rates of each of these depends on the location of the fracture, with some of the highest reported in tibial fractures.

 

A compression fracture is understood as a partial collapse of bone in relation to a fracture. The bodies of vertebrae are often sites of compression fractures, but other bone fractures are often compressed, for example tibia (shinbone) and calcaneus (heel bone) fractures.

Treatment options

When surgically treating a fracture the surgeon will often try to restore normal anatomy. For example in a tibia condyl fracture (top of the shinbone at the knee) where the joint articular surface is being compressed, the surgeon will 'lift' the fractured bone back into its normal anatomic position, thereby restoring the normal joint surface. However, this procedure leaves a bony defect/hole below the 'lifted' bone. To avoid prolonged fracture healing this defect is filled with a bone graft.

 

The bone graft is normally taken from the patient's own iliac crest (rim of the pelvis), requiring a second invasive surgical procedure.

 

Alternatively, CERAMENT® can be used to treat tibia condyl fractures by injecting it into the bone defect using a minimally invasive technique. Importantly the use of CERAMENT means that there is no need for a second surgical procedure.

 

In this indication CERAMENT must always be used together with internal or external fixation/repair (i.e. metalwork such as plates, screws and pins) to make sure the fracture is stabilized.

REFERENCES

Lenarz C et al. Timing of wound closure in open fractures based on cultures obtained after debridement. J Bone Joint Surg Am. 2010;92:1921–1926.

Pollak AN et al. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. LEAP Study Group, J Bone Joint Surg Am. 2010 Jan;92(1):7-15.

Zalavras CG et al. Management of open fractures and subsequent complications. J Bone Joint Surg Am. 2007 Apr; 89(4):884-95

Caudle RJ & Stern PJ. Severe open fractures of the tibia. J Bone Joint Surg Am. 1987;69:801–807.

Kim & Leopold. Gustilo-Anderson Classification. Clin Orthop Relat Res. 2012 Nov; 470(11): 3270–3274.

Ostermann PA et al. Local antibiotic therapy for severe open fractures: a review of 1085 consecutive cases. J Bone Joint Surg Br. 1995;77:93–97.

Gustilo RB et al. Classification of type III (severe) open fractures relative to treatment and results. Orthopedics. 1987 Dec;10(12):1781-8.