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Management of Posttraumatic Segmental Bone Defects

Dr. DeCoster is Professor and Vice Chair, Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM. Dr. Gehlert is Assistant Professor, Department of Orthopedics and Rehabilitation, University of New Mexico. Dr. Mikola is Assistant Professor, Department of Orthopedics and Rehabilitation, University of New Mexico. Dr. Pirela-Cruz is Associate Professor, Department of Orthopedics, Texas Tech University–El Paso, El Paso, TX.

Reprint requests: Dr. DeCoster, University of New Mexico, 2ACC, 2211 Lomas Boulevard NE, Al-buquerque, NM 87131-5296.

Because of difficulty in managing posttraumatic segmental bone defects and the resultant poor outcomes, amputation historically was the preferred treatment. Massive cancellous bone autograft has been the principal alternative to amputation. Primary shortening or use of the adjacent fibula as a graft also has been used to attempt limb salvage. Of more recent methods of management, bone transport with distraction osteogenesis has been suggested as the leading option for defects of 2 to 10 cm, but problems include delayed union at the docking site and prolonged treatment time. Free vascularized bone transfer has been suggested as the leading option for defects of 5 to 12 cm, but hypertrophy of the graft is unreliable and late fracture, common. Bone graft substitutes continue to be developed, but they have not yet reached clinical efficacy for posttraumatic segmental bone defects. Although each of the new techniques has shown some limited success, complications remain common.

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