Distraction of hypertrophic callus in the treatment of segmental bone loss in the femur. A case report.

The treatment of a comminuted open fracture of the lower extremity caused by high-energy trauma often requires serial debridements and preliminary external fixation before open reduction and internal fixation and wound closure10. The prevalence of complications, including delayed fracture-healing, nonunion, and deep infection, has stimulated interest in the use of the Ilizarov ring fixator, with initial shortening and early wound closure followed by a corticotomy and segmental bone transport for restoration of limb length11. The disadvantages of stabilization with a ring fixator and subsequent segmental bone transport include a high rate of delayed union or nonunion at the docking site, pin-loosening, pin-track infection, and the pain and inconvenience that are associated with the long treatment period7,12. We report the case of a patient who had a comminuted fracture of the distal part of the femur that was associated with a large osseous defect, hypertrophic callus formation, and deep infection. The patient was managed successfully with multiple debridements and distraction osteogenesis through the callus. A thirty-nine-year-old man who had been involved in a motorcycle accident was initially seen at another institution for the treatment of multiple injuries, including a pulmonary contusion, a grade-II head injury (a score of 8 points on the Glasgow coma scale18), a Le Fort type-I maxillary fracture, a bilateral mandibular fracture, fractures of the ninth thoracic and first lumbar vertebrae, a supracondylar fracture of the left humerus, a fracture of the left olecranon, a fracture of both bones of the left forearm, bilateral hand injuries, an intertrochanteric fracture of the left femur, and a comminuted, open, grade-IIIB6 supracondylar fracture of the left femur (a type-33 A3.3 fracture according to the AO/ASIF classification system8) associated with a loss of eight centimeters of segmental bone from the distal …