Massive bone defect in open leg fracture: A case report

Abstract

Open fractures with massive defects are likely the most challenging conditions to manage in traumatology, particularly due to the scarcity of cases described in the literature where limb preservation was feasible. This report illustrates the management of an open fracture with a massive bone defect in which the physicians recurred to amputation after an attempt to preserve the patient’s quality of life through initial reparative treatment. A 57-year-old male presented with an open fracture with a de novo 25-cm bone defect following a motorcycle accident. Despite the large laceration, the injury presented with a relatively conserved surrounding muscular tissue; the distal two-thirds of the tibia were missing; yet, no neurovascular damage was documented. The patient was managed with a temporary external fixator and antibiotic-loaded cement spacer. Due to the patient’s desire to ride his motorcycle again, the authors performed a custom-made tibiotalar nailing arthrodesis 22 weeks later. This case presented the risk of infection and low quality of life, which led to amputation 74 weeks after the nailing procedure was performed. The treatment remains challenging in cases of massive bone defects and a relatively preserved biological-functional environment, and efforts should be made to develop tailored strategies. Although individualized care provides patients with time and hope, it might still fail to guarantee a decent quality of life and risks being a temporary solution before reverting to amputation.