Reimplantation of a Large Extruded Segment of Bone in an Open Fracture

Abstract

Replacing an extruded segment of bone in an open fracture imposes a challenging decision concerning the best and safest patient management. There are numerous advantages to restoring the patient's own extruded bone segment to its original location, particularly when the bone segment is of structural importance. However, reimplantation of contaminated and avascular extruded bone segments can potentially result in serious infection or nonunion. There is no conclusive evidence regarding the best decontamination protocol for the safest use of the recovered bone segment as an autologous graft. Among the different chemical sterilization solutions 10% povidone-iodine and chlorhexidine gluconate solutions are the author's most preferred solutions. Regarding cellular toxicity, 10% povidone-iodine has been found to be the most favorable among the readily available solutions.

Keywords: Extruded bone; chlorhexidine gluconate; open fracture; povidine-iodine; reimplantation.