Houston Medical

Case Summary

Open Femur Fracture with Significant Bone Loss

This patient was a motorcycle passenger involved in an accident that occurred when the motorcycle tried to pass a car. The motorcycle driver was killed and the patient sustained an open femur fracture with bone loss to her right leg.

The principal injury involved the thigh bone above the knee, which was shattered into many pieces and from which, an approximately 10-centimeter fragment was lost. The soft tissue around the bone also sustained heavy damage.

Treatment/outcome

The patient came in under emergency care with a good deal of blood loss, along with the tissue and bone loss. Doctors first stabilized the patient, cleaned out the wound and stabilized the fracture with an internal metal rod and screws.

Initially, they discussed amputating the leg, which was not indicated because the nerves and the foot were functioning and one of two major blood vessels to the lower part of the leg was intact.

Soft tissue reconstruction in the leg became the first order of business for doctors. After about two months, a bone graft from patient's hip was placed around the metal rod. The bone graft was ultimately unsuccessful.

Next, doctors tried growing the existing bone by cutting one of the existing pieces in two and growing bone behind the cut. An external fixator - metal rods with clamps and pins - was attached outside the leg to hold the bone in place. Each day, the patient turned a bolt adjustment on the external fixator, which gradually lengthened the bone. After several months, patient experienced difficulty with the frame, though about 3 centimeters of bone had regrown.

With 7 centimeters of bone still needing to be grown to replace lost bone, a piece of femur was cut from a cadaver bone. Doctors cut the bone to fit the space and inserted a metal rod in the middle of the bone to keep it in place.

Growth of muscles and vessels onto and into the new bone will take up to two years. The procedure has been successful, and the leg is back to its normal length. Patient is walking with a cane. The ultimate goal is for the cadaver bone to be incorporated by her thigh bone, after which the patient should see increased use and should be able to walk, function and work.

Physicians

Dr. Kevin J. Coupe is board-certified in orthopedic surgery with a specialty in acute and reconstructive orthopedic trauma.

Dr. Michael Kent is completing a residency in orthopedic surgery.

Both doctors are affiliated with The University of Texas Medical School at Houston.

Web resources:

American Academy of Orthopaedic Surgeons/American Association of Orthopaedic Surgeons