Staged Reconstruction of Diaphyseal Fractures with Segmental Defects: Surgical and Patient-Reported Outcomes

Publication date: Available online 23 June 2017
Source:Injury
Author(s): S.D. Zoller, L.A. Cao, R.A. Smith, W. Sheppard, E.L. Lord, C.D. Hamad, J.H. Ghodasra, C. Lee, D. Jeffcoat
IntroductionTwo-stage limb reconstruction is an option for patients with critical size segmental bone defects following acute trauma or non-union. Reconstruction is technically demanding and associated with a high complication rate. Current protocols for limb reconstruction have well-documented challenges, and no study has reported on patient outcomes using a validated questionnaire. In this study, we aimed to examine the clinical and patient-centered outcomes following our surgical protocol for two-stage limb reconstruction following critical size segmental defects.Patients and methodsA single surgeon performed reconstruction of long bone defects using antibiotic impregnated cement spacers and intramedullary cancellous bone autograft. A retrospective chart review was performed. Three reviewers independently measured time to union based on radiographs. The Lower Extremity Functional Scale (LEFS) survey was administered to patients after most recent follow-up.ResultsTen limbs representing nine patients were included. All patients sustained a lower extremity injury, and one patient had bilateral lower extremity injuries. Average clinical follow-up was 18.3 months (range 7–33) from final surgical intervention, and follow-up to questionnaire administration was 28 months (range 24–37). The mean time between stages was 3.1 months. Average time to unrestricted weight-bearing was 7.9 months from Stage 1 (range 3.4–15.9) and 4.5 months from Stage 2 (range 1.1–11.6). Average time to full union was 16.7 months from Stage 1 (range 6.4–28.6) and 13.5 months from Stage 2 (range 1.8–27). Eight patients (nine limbs) participated in the LEFS survey, the average score was 53.1 (range 30–67), equating to 66% of full functionality (range 38% − 84%). Complications included 5 infections, 3 non-unions, and one amputation. There was a moderate positive correlation between infection at any time point and non-union (R=0.65, p=0.03).Discussion and conclusionsOutcomes in this small patient cohort were good despite risks of complication. There is an association between infection and non-union. Further studies addressing clinical and functional outcomes will help to guide expectations for future surgeons and patients.



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