Military Medicine Congress in Abu Dhabi: New techniques help patients avoid amputation

Detailed summary

Dr Austin Fragomen of the Hospital for Special Surgery in the United States said bone transport was among the techniques used to address large bone defects ...

Patients with severe battlefield injuries can lose substantial sections of bone, leaving surgeons with the difficult choice of attempting complex reconstruction or proceeding with amputation. But advances in limb reconstruction are allowing doctors to rebuild even large defects using the patient's own bone.

Dr Austin Fragomen of the Hospital for Special Surgery in the United States presented several techniques used to reconstruct severely damaged limbs, including cases involving soldiers and patients with complicated fractures, infections and extensive soft-tissue injuries.

Speaking at the International Congress for Military Medicine in Abu Dhabi, Fragomen said bone transport was among the techniques used to address large bone defects that cannot be adequately treated with conventional bone grafting.

The procedure involves cutting a section of healthy bone and gradually moving it across the missing section. As the bone is transported, new bone forms behind it, progressively filling the defect.

One of the established methods uses a circular external fixation device, based on the Ilizarov technique, to guide the movement and support the bone as it heals.

Fragomen also described more modern computer-assisted external fixation systems that help surgeons control the direction of bone movement and ensure the transported section reaches the intended position.

However, newer techniques are increasingly allowing surgeons to carry out bone transport using internal devices, reducing the time patients need to spend wearing external frames.

In one case, he described treating a soldier with a severely damaged knee, repeated infected surgical reconstructions and a large bone defect. The patient had faced the possibility of an above-knee amputation but wanted to pursue limb salvage.

Fragomen used an internal bone-transport nail, supported by an external fixation system, to gradually move a section of bone across a defect measuring approximately 15cm.

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