Challenge of the Week / Trauma / 01.22.2021

A 25-year-old male patient sustains an open tibial shaft fracture after a high-speed motor-vehicle collision. He is treated initially with serial irrigation and debridement, which leaves the tibia with a clean 4-cm midshaft cortical defect with good soft- tissue coverage. Definitive management should include open reduction and internal fixation with:

    • Placement of bone morphogenetic protein (BMP) into the defect
    • The clinical application of bone morphogenetic protein (BMP) in a 4-cm cortical defect is limited

 

    • Acute shortening
    • Acute shortening should not be performed for defects of >3 cm

 

    • Platelet-rich plasma (PRP) in the defect
    • Platelet-rich plasma (PRP) has not been shown to have a definitive effect on bone healing

 

    • Placement of autologous bone graft into the defect
    • Autologous bone graft is a good option for bone loss of 4 cm

     

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