Spontaneous Bone Regeneration After Traumatic Bone Loss in Young Patient A Case Report

Case Report
Surgery and Clinical Practice
Spontaneous Bone Regeneration after Traumatic Bone Loss in Young

Patient: A Case Report
Barreca S¹, Lacquaniti D¹, Calabrò G¹, Scordino FM¹, Morena A¹, Ventra M¹, Macheda S², Tescione M²
and Piccolo A²
¹Unità Operativa Complessa Ortopedia e Traumatologia, Grande Ospedale

*
Correspondence:
Metropolitano “Bianchi Melacrino Morelli”, Reggio di Calabria, Italy. Barreca S, Unità Operativa Complessa Ortopedia e Traumatologia,
Grande Ospedale Metropolitano “Bianchi Melacrino Morelli”,
²Unità Operativa Complessa Terapia Intensiva e Anestesia, Grande Reggio di Calabria, Italy.
Ospedale Metropolitano “Bianchi Melacrino Morelli”, Reggio di Calabria,
Italy. Received: 04 Sep 2024; Accepted: 22 Oct 2024; Published: 30 Oct 2024
Citation: Barreca S, Lacquaniti D, Calabrò G, et al. Spontaneous Bone Regeneration after Traumatic Bone Loss in Young Patient: A Case
Report. Surg Clin Prac. 2024; 1(1): 1-4.
ABSTRACT
Bone loss represents both clinical and technical challenge for orthopedic surgeons. There are several surgical options
for the treatment of these patients, but currently no specific guidelines on the best management of these injuries are
available.
We present the case of a young male patient (12 years old) diagnosed with an open distal tibial fracture with bone
loss (about 8 centimeters), a closed distal fibula fracture and posterior tibial nerve and posterior tibial arterial
injuries, due to a high energy road trauma. The orthopedic surgery team scheduled tissue debridement and nerve
repair, followed by the positioning of a monoaxial external fixator. Surprisingly, an x-ray performed 30 days after the
surgical treatment showed a spontaneous improvement in terms of bone regeneration. Orthopedic surgeons decided
to have a “wait and see approach”. A clinical follow up was scheduled in the following months and, after a year, bone
was completely regenerated.
Keywords occurred, asking ourselves if a wait-and-see approach could be a

Bone regeneration, Tibial fractures, Orthopedic surgery, Fracture weapon in the hands of surgeons in the treatment of this type of
fixation, Case reports. injury.
Introduction Case Report

Management of bone loss is a big challenge in orthopedic surgery, A 12 years-old male patient was admitted to our Emergency
representing a potential minefield for clinicians. Its management Department (ED) following a high energy road trauma. He
requires a careful clinical planning, a highly qualified technical arrived conscious (GCS 15) with stable vital signs. He presented
approach and, not last, a lot of compliance by the patient. Segmental an open fracture of the distal portion of left tibia with bone loss.
bone loss may occur following a high energy trauma. Tibia is the Lacking bone was collected on the trauma scene, but it was highly
contaminated, and it could not be used for bone replantation. Deep
bone most frequently involved: the soft tissue covering its surface
irrigation of the wound was performed immediately in the ED.
is very thin, making the bone susceptible to open fracture and
Clinical history was collected, and blood lab tests were executed.
bone extrusion [1]. These patients have a high risk of vascular and Prompt antibiotic therapy was started. Whole-body computed
infectious complications, so careful treatment of these types of tomography (CT) scan with contrast was performed, confirming the
injuries is necessary. Nowadays, several surgical techniques are presence of a type III C Gustilo tibial fracture with bone loss (about
available, but no specific guidelines have been established [2,3]. 8 cm), highlighting a closed distal fibula fracture, with posterior
We report the case of a young patient with tibial bone loss after a tibial nerve and posterior tibial arterial injuries. Immediately,
high energy road trauma, in whom spontaneous bone regeneration the patient was transferred to the operating room for wound
Surg Clin Prac, 2024 Volume 1 | Issue 1 | 1 of 4

revision and debridement, nerve injury repair and positioning of Orthopedic surgeons opted for a wait-and-see approach. Monthly
monoaxial external fixator with 6 screws (3 in diaphyseal tibia and x-rays and clinical check were scheduled and performed. Weight
3 in calcaneus) [Image 1]. At the same time the vascular surgeon – bearing was not allowed for the first six months. Then, partial
repaired the posterior tibial arterial injury. The post-surgery period weight - bearing was permitted, keeping the external fixator.
was uneventful. X-ray was performed after two weeks [Image 2] During the following months a constant augment of regenerated
and thirty days [Image 3] from the traumatic event, the patient bone was observed. After 12 months, x- rays showed complete
was re-evaluated, and complete wound healing was evident at
bone regeneration and the external fixator was removed [Image 4].
physical examination. Surprisingly, diagnostic images showed
initial spontaneous bone regeneration. After two years, the patient had an excellent functional recovery
[Image 5] and was satisfied with the clinical results.
Image 1: Immediately post orthopedic surgery (July 2019).
Image 2: Two weeks post surgery.

Image 3: A month post-surgery.
Image 4: A year post surgery.

Image 5: Two years post surgery.
Discussion References
Bone loss represents both clinical and technical challenge for 1. Wang H, Yuan H, Liu L, et al. Incidence, characteristics,
orthopedic surgeons. Several surgical options for the treatment and treatments of traumatic open fractures in children and
of these injuries exist [4,5,6] but, currently, no specific guideline adolescents: A retrospective observational study. Medicine
on their best management is available. Currently, the surgical (Baltimore). 2022; 101: e29828.
approach is recommended for adult patients and for young patients 2. Adamczyk A, Meulenkamp B, Wilken G, et al. Managing
in the age of growth, with post-traumatic bone loss. Non-operative bone loss in open fractures. OTA Int. 2020; 3: e059.
management may be indicated as a first therapeutic approach in 3. Keating JF, Simpson AH, Robinson CM. The management of
young patients in whom skeletal maturity has not been reached. To fractures with bone loss. J Bone Joint Surg Br. 2005; 87: 142-
apply safely a “wait and see approach”, it is recommended a close 50.
clinical monitoring to detect earlier complications. 4. Devendra A, Velmurugesan PS, Dheenadhayalan J, et al.
One-Bone Forearm Reconstruction: A Salvage Solution for
We used a “wait and see approach” in our patient, encouraged by the the Forearm with Massive Bone Loss. J Bone Joint Surg Am.
radiological images acquired after primary surgery, hypothesizing 2019; 101: e74.
the presence of residual periosteum which would have allowed 5. Smith WR, Elbatrawy YA, Andreassen GS, et al. Treatment
complete bone regeneration. We showed that this conservative of traumatic forearm bone loss with Ilizarov ring fixation and
approach may be an alternative method for the treatment of these bone transport. Int Orthop. 2007; 31: 165-70.
injuries, avoiding repeated surgery and, consequently, reducing 6. Plotnikovs K, Ribakovs O, Movcans J, et al. A 52-Year-
the risk of complications, such as acute blood loss and surgical Old Man with a Gustillo-Anderson IIIB Open Tibial Shaft
site infection [7,8] and permitting a full recovery of functional Fracture with Extensive Soft-Tissue Defect Requiring Limb
Salvage with Artificial Deformity-Creating Technique. Am J
capability. Wait and see approach could be a good option in young
Case Rep. 2022; 23: e934788.
patient.
7. Atef A, El-Tantawy A. Management of open infected
comminuted tibial fractures using Ilizarov concept. Eur J
Orthop Surg Traumatol. 2014; 24: 403-8.
8. Magnussen RA, Tressler MA, Obremskey WT, et al.
Predicting blood loss in isolated pelvic and acetabular high-
energy trauma. J Orthop Trauma. 2007; 21: 603-7.
© 2024 Barreca S, et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

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Case Report

Surgery and Clinical Practice

Spontaneous Bone Regeneration after Traumatic Bone Loss in Young

¹Unità Operativa Complessa Ortopedia e Traumatologia, Grande Ospedale

Keywords occurred, asking ourselves if a wait-and-see approach could be a

Introduction Case Report

Surg Clin Prac, 2024 Volume 1 | Issue 1 | 1 of 4

Image 1: Immediately post orthopedic surgery (July 2019).

Image 2: Two weeks post surgery.

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Image 4: A year post surgery.

Surg Clin Prac, 2024 Volume 1 | Issue 1 | 3 of 4

Surg Clin Prac, 2024 Volume 1 | Issue 1 | 4 of 4

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