Management of open femur fractures with massive bone loss using two-stage vascularized fibula grafting and synthetic calcium sulfate: A report of two cases

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-28 DOI:10.1016/j.jcot.2025.103037

Ajayakumar Thankappan, Nizaj Nasimudeen, Aadithya Rangarajan

引用次数: 0

Abstract

Type III Gustilo-Anderson fractures with massive bone loss present significant treatment challenges due to the extensive bony and soft tissue damage they entail. Poor management can lead to complications such as osteomyelitis, non-union, limb length discrepancies, or even amputation. We present two cases of 52- and 56-year-old adults who had complex intra-articular distal femur open fractures with massive bone loss of 21 cm and 18 cm, respectively, successfully managed using synthetic calcium sulfate beads and vascularized fibula grafting.

The use of calcium sulfate offers several advantages over polymethylmethacrylate (PMMA) beads, including more effective antibiotic delivery, greater osteogenicity, and reduced systemic toxicity of antibiotics. We recommend the use of calcium sulfate over PMMA in managing complex cases with bone defects.

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两期带血管腓骨植骨联合合成硫酸钙治疗开放性股骨骨折伴大量骨丢失2例报告

III型Gustilo-Anderson骨折伴大量骨质流失，由于其所带来的广泛骨和软组织损伤，给治疗带来了重大挑战。管理不善可导致并发症，如骨髓炎，不愈合，肢体长度差异，甚至截肢。我们报告了两例52岁和56岁的成年人，他们患有复杂的股骨远端关节内开放性骨折，分别有21厘米和18厘米的大量骨质流失，他们成功地使用了合成硫酸钙珠和带血管的腓骨移植。与聚甲基丙烯酸甲酯（PMMA）微球相比，硫酸钙的使用有几个优点，包括更有效的抗生素递送、更强的成骨性和更低的抗生素全身毒性。我们建议在处理复杂的骨缺损病例时使用硫酸钙而不是PMMA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.