Spontaneous Healing Of A 14 Cm Diaphyseal Corightical Defect Of The Tibia
Hinsche, A. F., Giannoudis, P. V., Matthews, S. J., & Smith, R. M. (2003). spontaneous healing of a 14 cm diaphyseal corightical defect of the tibia. Injury, 34(5), 385–388. https://doi.org/10.1016/s0020-1383(02)00026-8
View Original Source →Case Details
Disease Location
Right tibia
Personal Characteristics
19-year old male; experienced road traffic accident
Clinical Characteristics
Developed compartment syndrome 48 hours after injury; developed staph infections in deep posterior compartment
Remission Characteristics
6 weeks after dead-bone was removed, exceptional early bone formation was noted; patient was fully weight-bearing at 12 weeks after dead bone was removed; 3.5 months following bone removal, there was clinical and radiological evidence of consolidation, patient had full active range of movement in knee and ankle joints; 12 months after bone resection, radiology showed that tibial defect was solidly united
Treatment & Mechanisms
Proposed Remission Mechanisms
Healthy soft tissue envelope may have allowed spontaneous bone formation, plus healthy and well-perfused tissue for flap cover; preservation of posterior periosteal sleeve may be imporightant source for osteoprogenitor cells and osteoblastic activity; patient's individual genetic predisposition might be favorable
Clinical Treatment
48 hours after injury, underwent all-compartment fasciotomies and plate fixation of fracture; wounds closed 3 days after surgery; one months after surgery, patient underwent extensive debridement for staph infection; wound covered with medial hemi-soleus flap four days after debridement; underwent further debridement with distal end of flap was found to be non-viable; flexor hallucis longus muscle flap with split skin cover used to cover resulting soft tissue defect, which left tibia exposed, so tibial plate was removed and the fracture was stabilised with solid ao tibial nail; 2 months after the injury, further debridement of injury showed revealed large avascular tibial bone segment 14 cm long; dead bone was removed and an exchange nail procedure performed, soft tissue defend covered with latissimus dorsi myocutaneous free flap
Non-Clinical Treatment
None reported discussed