Bone Defect Case Studies

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INTRODUCTION
Segmental bone defects can occur due to various etiologies and are complex tiring problem to deal with, for the surgeon, as well as for the patient. Bone defects can occur due to trauma, bone infection, congenital defects, excision of malignant tumors. Due to considerable long term morbidity, historically, amputation was the preferred treatment. Limb salvage has been tried with the use of bone grafts, bone transport and acute limb shortening. Vascularised bone grafting is technically demanding.(1,2) Traditional bone grafting techniques are limited by uncontrollable graft resorption. Ilizarov technique has been associated with adjacent joint stiffness and certain other complications.(3,4) In 1986, French surgeon A.C. Masquelet conceived
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Approximately after 6 weeks, depending upon soft tissue condition, second stage was undertaken. Cancellous autograft was harvested from iliac crest. If the bone defect was too large allograft was mixed, making upto 33% of volume of the graft. In a few cases, cortical sliver from the iliac crest were also mixed with the graft. The bone defect was approached from the previous incision and careful dissection performed down to the defect. Careful incision was given over the induced biomembrane. The cement spacer was removed enbloc or in a piecemeal fashion. Care is taken to not to put any stress on the fixation construct. Biomembrane is irrigated to remove any debris. Then entire void was filled with the graft, care taken not to overstuff the void as this will make closure of biomembrane difficult. The biomembrane was repaired with absorbable vicryl sutures if possible, otherwise the soft tissue over it was repaired making the membrane fall back into place covering the graft completely. Watertight fascial closure was done, followed by skin closure using nylon.
Post operative protocol. Patients were allowed immediate passive and active motion and non-weight bearing mobilisation. Toe touch weight bearing was started after 12 weeks of second stage. Full weight bearing was allowed after obtaining radiological union. A few patients in the study had multiple traumas. For such patients, mobilisation and weight bearing were delayed as required. But all efforts were aimed at aggressive physiotherapy and early

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