Reimplantation of an Extruded Humeral Segment into an Intact Periosteal Envelope in a Child: A Case Report.

Abstract

Traumatic bone extrusion followed by successful bone-segment reimplantation is uncommon1-4. When bone loss is minimal, open fractures may heal by stabilization alone, and small amounts of bone loss can generally be treated with an autogenous or allogenic bone graft. Large segmental bone defects may occur at the time of injury or after surgical debridement of devitalized bone, and may require large grafts, multiple grafts, vascularized bone grafts, or bone transport5-7. The benefits of reimplanting an extruded segment include maintenance of the original skeletal structure, avoidance of morbidity associated with autogenous bone harvesting, and avoidance of allograft bone procedures or prolonged bone transport procedures. Regardless of the sterilization method used, reimplantation of a devascularized bone segment after meticulous wound debridement and sound bone stabilization is associated with an elevated risk of infection. However, the literature lacks guidelines regarding the sterilization, timing of reimplantation, and stabilization of extruded bone segments1-4. We describe a case of early reimplantation of an extruded humeral segment in a child. The patient and her family were informed that data from this case would be submitted for publication, and they provided consent. A three-year-old girl fell from a third-floor balcony of an apartment and sustained an injury to the right arm and elbow. Her general condition was good, and she was alert and oriented. Other injuries included only a small scalp laceration and multiple superficial abrasions over the lower extremities. Physical examination revealed a 3-cm transverse laceration on the posterior aspect of the distal part of the right arm (just proximal to the olecranon) with moderate contamination, and gross motion indicating skeletal instability. A missing segment of humerus measuring 7.5 cm was retrieved by the parents from the scene approximately sixty minutes after the accident. The …