Spontaneous Healing Of A Traumatic Critical Radius Bone Defect In Adolescent: A Rare Case Report
Kurniawan, A., Wijaya, T., & Hutami, W. D. (2021). Spontaneous healing of a traumatic critical radius bone defect in adolescent: A rare case report. International journal of surgery case reports, 81, 105806. https://doi.org/10.1016/j.ijscr.2021.105806
View Original Source →Abstract
INTRODUCTION AND IMPORTANCE: Fracture with a critical bone loss is associated with a profound burden of disease impact. Although there are several options exist for its treatment, but still those reconstructive procedures are technically demanding, relatively expensive and sometimes the result is less than what was expected. The objective of this study is to report a rare case of spontaneous healing of a critical radial bone defect in an adolescent. CASE PRESENTATION: We reported a 15 year old boy with a segmental open fracture of left radius, open fracture of left distal shaft ulna and closed fracture of left intercondylar humerus. The middle fragment of a fractured radius was extruded out, pulled out and then thrown away by his parent. Debridement, open reduction, and internal fixation for ulna were performed as well as reposition and internal fixation for the intercondylar humerus fracture. The plan was to wait until the ulnar fracture and intercondylar fracture to heal without any sign of infection and proceed to overcome the radial critical bone defect. This case report had been reported in line with SCARE criteria. The patient showed up seven months later with solid union of the critical radius bone defect and fully functioning hand with only slight limitation in pronation. CLINICAL DISCUSSION: Osteogenesis in fracture requires osteogenic cells, osteoinductive components, osteoconductive scaffold, and stability. Despite the fact that critical bone defect poses great challenge for its management, intact periosteum and sufficient soft tissue perfusion were able to provide those biologic requirements adequately for fracture healing and ensure spontaneous healing of a traumatic critical bone loss in adolescent without any reconstructive procedure. CONCLUSION: Spontaneous healing in critical bone defect is possible, provided all the favorable factors present to support this phenomenon.
Case Details
Disease Location
Radius, ulna
Personal Characteristics
15 year old boy
Clinical Characteristics
History of falling from a tree 26 h prior to admission. He fell with his left elbow in full extension and had an open segmental fracture of left radius, an open fracture of the left distal shaft ulna and a closed fracture of the left intercondylar humerus. The middle fragment of the radius fracture was pulled out and thrown away unpurposely by his parent because it was mistakenly identified as wood that pierced the arm. Physical examination at the time of admission revealed swelling and angulation on the left distal forearm with an open wound size 3 × 0.5 cm. Anteroposterior and lateral view radiographs of the left forearm showed a transverse fracture of the distal shaft ulna with displacement to the side. There was 9 cm (38%) bone loss of the radius that started from the mid-shaft radius to the metaphysis of the distal radius. The patient was diagnosed with an open segmental fracture of the left radius with bone loss, an open fracture of the left distal shaft ulna gustillo-anderson grade ii, and a closed fracture of the left intercondylar humerus (rains riseborough type ii). Two-stage surgeries were carried out, with the emergency debridement and application of a back slab. The wound was left open due to soft tissue swelling. The second surgery was performed a week later, during which open reduction and internal fixation of the ulnar fracture and the intercondylar humerus fracture were performed, still with the application of a backslap postoperatively. The radius bone defect was left untouched.
Remission Characteristics
At 7 months follow up, the patient had no pain nor deformity on the forearm and elbow. The 7-month postoperative x ray showed that the fracture of the ulna and intercondylar humerus had been united, and the radius critical bone defect was filled with solid bone with no gross angulation
Treatment & Mechanisms
Proposed Remission Mechanisms
He patient is 15 years of age which can still be considered as within growth spurt of puberty during which the osteogenesis is enhanced due to the presence of sex hormone. The presence of sex hormone during growth spurt may enhance fracture healing
Clinical Treatment
Emergency debridement and application of a back slab. Open reduction and internal fixation. Physical therapy