A novel technique for reimplanting extruded bone fragments in open fractures

Abstract Extruded bone fragments are a rare complication of high-energy open fractures. Generally, management is thorough debridement and managing the bone defect. In the literature, there are only a few case reports where successful retention of the free bone fragment has been done. Disinfection of bone fragment is done by autoclaving or use of antiseptic/antibiotic solution. Autoclaving leads to complete loss of viable cells and antiseptic/antibiotic solutions do not disinfect completely. In this case report, authors present an innovative technique of disinfecting the bone fragment effectively with minimum compromise on biology. A 38-year-old male with compound grade III B comminuted fracture of distal femur with 2 extruding bone pieces was managed by thorough debridement, external fixator and antibiotic cement spacer. The extruded bone fragments were rinsed in saline and diluted betadine and implanted in subfascial plane in healthy soft tissues in the thigh along with a few antibiotic beads for assuring disinfection. After 1 week, when no clinical signs of infection were found, the site was opened, cement spacer removed, free fragments positioned anatomically and rigid internal fixation was done. Fracture united at 6 months with good functional outcome. At last follow-up at 1 year, the patient was mobilising freely and there were no signs of low grade infection. The key points of this procedure are: 1) Viability of bone fragment maintained while achieving disinfection. 2) Traumatised soft tissues healed and prepared for accepting the free bone fragment. 3) Use of antibiotic cement counters any remaining chances of infection after thorough debridement. 4) Faster union with maintenance of bone length and alignment with use of anatomic fragments. Extensive search of literature was done and this procedure was found to be novel. A larger case series can help in determining the utility of this technique in compound fractures.