Iliac bone graft for the treatment of bone loss and non-union of the distal radius.: A polytraumatized patient with an open Gustilo IIIB wrist fracture

Iliac bone graft for the treatment of bone loss and non-union of the distal radius.

A polytraumatized patient with an open Gustilo IIIB wrist fracture

Authors

  • Michela Saracco Università Cattolica del Sacro Cuore di Roma
  • Gianfranco Merendi Università Cattolica del Sacro Cuore di Roma
  • Lorenzo Rocchi Università Cattolica del Sacro Cuore di Roma

Keywords:

open wrist facture, non-union, iliac bone graft

Abstract

Background/Aim of the work: Open distal radius fractures are rare compared to closed ones. They mainly affect young people with high-energy trauma and are burdened with a high number of complications, including non-union. In this case report, we describe the technique used to manage bone loss and non-union of the distal radius of a polytraumatized patient with an open Gustilo IIIB fracture of the wrist.

Case Report: 58-year-old man, suffering from head trauma and open right wrist fracture after motorcycle accident, underwent emergency damage control with debridement, antibiotic prophylaxis and stabilization in an external fixator. Then, he developed infection and bone loss, associated with an injury of the median nerve.  Non-union were treated with iliac crest bone graft, open reduction and internal fixation (ORIF).

Outcomes: At the follow-up 6 months after the bone graft and ORIF procedure and 9 months after the trauma, the patient was clinically healed, with good performance status.

Conclusions: Treatment of non-union in open distal radius fractures with iliac crest bone graft is a viable, safe and easy surgical choice.

References

Bonafede M, Espindle D, Bower AG. The direct and indirect costs of long bone fractures in a working age US population. J Med Econ 2013; 16(1):169-78.

MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 2016; 29(2):136-45.

Jawa A. Open fractures of the distal radius. J Hand Surg Am 2010; 35(8):1348–50.

Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24(8):742–6.

Agha RA, Franchi T, Sohrabi C, Mathew G, Kerwan A; SCARE Group. The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines. Int J Surg 2020; S1743-9191(20)30771-8.

Pagliei A, Tulli A, Rocchi L. "Square sail" flap in median nerve lesions at the wrist. Anatomical elements and review of twenty operated cases. Chir Main 2003; 22(3):125-30.

Mathews AL, Chung KC. Management of complications of distal radius fractures. Hand Clin 2015; 31(2):205-15.

Prommersberger KJ, Van Schoonhoven J, Lanz UB. Outcome after corrective osteotomy for malunited fractures of the distal end of the radius. J Hand Surg Br 2002; 27(1):55-60.

Bytyqi C, Qorraj H, Tolaj A, Hajdari R. Corrective osteotomy of distal radius malunion after IIIB open fracture: Palmar approach - Case report. Int J Surg Case Rep 2019; 58:193-7.

MacKay BJ, Montero N, Paksima N. Outcomes following operative treatment of open fractures of the distal radius: a case control study. Iowa Orthop J 2013; 33:12–8.

Iorio ML, Harper CM, Rozental TD. Open Distal Radius Fractures: Timing and Strategies for Surgical Management. Hand Clin 2018; 34(1):33-40.

Fernandez DL. Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg Am 1982; 64:1164–78.

Smeraglia F, Basso MA, Fonzone Caccese A, Bernasconi A, Mariconda M, Balato G. Volar distal radius vascularized bone graft vs non-vascularized bone graft: a prospective comparative study. J Biol Regul Homeost Agents 2020; 34(3Suppl.2):115-20.

Noaman HH. Management of upper limb bone defects using free vascularized osteoseptocutaneous fibular bone graft. Ann Plast Surg. 2013; 71(5):503-9.

Liu K, Mu L, Liu J, Fu Z, Chen L, Liu B. Distal radius fracture malunion in an adolescent patient treated with osteotomy and autologous iliac bone grafting: A case report. Medicine (Baltimore). 2020;99(40):e22535.

Braga-Silva J, Peruchi FM, Moschen GM, Gehlen D, Padoin AV. A comparison of the use of distal radius vascularised bone graft and non-vascularised iliac crest bone graft in the treatment of non-union of scaphoid fractures. J Hand Surg Eur Vol 2008;33(5):636-40.

Kim JK, Yoon JO, Baek H. Corticocancellous bone graft vs cancellous bone graft for the management of unstable scaphoid nonunion. Orthop Traumatol Surg Res 2018;104(1):115-20.

Downloads

Published

23-06-2023

How to Cite

1.
Iliac bone graft for the treatment of bone loss and non-union of the distal radius.: A polytraumatized patient with an open Gustilo IIIB wrist fracture. Acta Biomed [Internet]. 2023 Jun. 23 [cited 2024 Jun. 22];94(S2):e2023049. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/12485