Creating bone: Case study of different methods of reconstruction in destroyed extremities

Introduction: The reconstruction of extremities after trauma, such as blast, gunshot injuries and accidents involve a prolonged process to recreate a functional limb. For successful reconstruction, a vital and intact soft tissue needs to be crafted first. After conditioning the soft tissue in addition to debriding infected and avital material, bone defects tend to arise. To recreate viable bone structure, Masquelet-technique is followed by closed methods such as internal transport techniques or open methods with external fixator. An enhanced form of internal transport is known as plate assisted bone segment transport (PABST). Aim of this case series is to give a short overview of possible ways of reconstruction of the lower limb.
Cases: Cases from the last two years have been analysed, including: a 22 year old male after motorbike injury with a second-degree open tibia fracture, treated with external transport, an additional tibia nail and an vascularized latissimus dorsi free flap for soft tissue conditioning; a 36 year old male after bruise trauma with a third-degree open tibia fracture, treated with PABST, and soft tissue conditioning with an ALT-flap; a 46 year old male with gunshot injury with femur fracture, initially treated with intramedullary nail followed by PABST.
Discussion: PABST can be used to handle the main negative aspects of internal transport, such as axial deviation and implant failure, by supporting the bone with an internal fixation. In contrast, several options for axial correction exist for external transport. The greatest concern in reconstructing extremities is the risk of secondary infection of reproduced bone structure. The cases show comparable results between internal and external transport techniques. Future assessment of more cases is needed to analyse the limits and advantages for the different methods.

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