Managing Bone Defects After Severe Leg Injury: Expert Advice

Defect of the right calf bone?

Hello, doctor! I would like to ask about a serious car accident I had in early November last year, where my leg was trapped inside the vehicle.
When the firefighters rescued me, I saw that my right calf was completely mangled and bloodied.
Later, at the hospital, the doctor informed me that I had a severe open, comminuted fracture.
Although I received emergency disinfection and debridement, I had to wait in the emergency room for 6 to 7 hours before going into surgery.
Initially, due to the large area of the open wound, they could only use external fixation and clean the wound inside.
I then underwent several debridement surgeries.
At the end of November, I had internal fixation surgery, where they used donated bone from a bone bank to fill the bone defect, along with a flap transfer surgery to cover the wound.
After two weeks of observation, it seemed that the flap transfer failed due to poor blood circulation.
I then had another surgery, where they took a blood vessel from my left calf and connected it to the severed vessel in my right calf, and also took muscle from my thigh to repair the injured area.
This surgery was finally successful, and blood circulation was restored.
Following that, I underwent a skin graft surgery and was discharged home at the end of December for recovery.
However, it has now been over 9 months since the internal fixation surgery, and there has been no progress in the bone defect area; the bone is not healing.
Additionally, due to damage to the nerves, ligaments, and soft tissues, I have almost lost sensation in my foot, which is constantly sore and feels like gout or rheumatic pain.
I have been taking B12 to see if it can help with nerve repair, but my main concern now is the bone defect.
I do not want to undergo another surgery, so I would like to ask the doctor for any good suggestions.
I regularly take calcium supplements and drink milk as well.

Hsieh Chun-Chih, 30~39 year old female. Ask Date: 2021/09/10

Dr. Shi Guozheng reply Orthopedics

If the bone does not grow back after a full year, it may be considered non-union, and at that point, surgical intervention to promote bone healing may be necessary.
This would involve another surgery to address the issue.

Reply Date: 2021/09/10

More Info

I'm sorry to hear about your severe leg injury and the challenges you've faced during your recovery. Managing bone defects after a significant injury, especially one involving open and comminuted fractures, can be complex and requires a multidisciplinary approach. Here’s a comprehensive overview of your situation and some recommendations based on current medical practices.

Understanding Bone Healing and Defects
After a severe injury like yours, the body goes through several stages of healing. Initially, the inflammatory phase occurs, followed by the reparative phase, where new bone begins to form. In cases of significant bone loss or complex fractures, such as yours, the healing process can be prolonged and may not proceed as expected. Factors that can influence bone healing include:
1. Blood Supply: Adequate blood flow is crucial for bone healing. Any compromise, such as in your case with the failed flap transfer, can significantly hinder recovery.

2. Infection: Open fractures are at a higher risk for infection, which can impede healing and lead to complications.

3. Nutritional Status: Adequate nutrition, including calcium and vitamin D, is essential for bone health. Vitamin B12 may help with nerve repair, but it’s also important to ensure you’re getting enough calcium and protein.

4. Mechanical Stability: The stability of the fracture site, often achieved through surgical intervention, is vital for bone healing. If the fixation is inadequate, it can lead to non-union or delayed union.

Recommendations for Managing Bone Defects
1. Regular Follow-ups: Continue to have regular follow-ups with your orthopedic surgeon. They can monitor the healing process through imaging studies like X-rays or CT scans to assess bone growth and alignment.

2. Bone Grafting: If there is a significant bone defect that is not healing, your surgeon may consider additional bone grafting procedures. This could involve using autologous bone (bone taken from another site in your body) or synthetic graft materials.

3. Physical Therapy: Engaging in a structured physical therapy program can help improve mobility and strength in your leg. A physical therapist can also provide exercises that promote circulation and potentially enhance healing.

4. Pain Management: Since you are experiencing chronic pain, it’s important to discuss this with your healthcare provider. They may recommend medications or therapies to help manage your pain more effectively.

5. Nutritional Support: Ensure you are consuming a balanced diet rich in calcium and vitamin D. Consider consulting a nutritionist who specializes in recovery from injuries to optimize your diet for healing.

6. Consider Advanced Therapies: Depending on your situation, your doctor might suggest advanced therapies such as electrical stimulation or ultrasound therapy, which have been shown to promote bone healing in some cases.

7. Psychological Support: Dealing with a severe injury and the associated pain can be mentally taxing. Consider seeking support from a psychologist or counselor who can help you cope with the emotional aspects of your recovery.

Conclusion
While it’s understandable to be apprehensive about undergoing further surgery, it’s essential to maintain open communication with your healthcare team. They can provide tailored advice based on your specific situation and help you weigh the risks and benefits of any additional procedures. Remember, healing takes time, and it’s important to be patient with your body as it recovers from such a significant trauma.

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