A narrative review by Keating et al. (Edinburgh, 2005) synthesising the epidemiology, classification, and surgical management of fractures with significant bone loss — from initial limb-salvage decision-making through definitive skeletal reconstruction — and providing a management algorithm based on defect size, location, and soft-tissue status.
When you encounter an open fracture with bone loss, use defect size as your primary decision branch: defects under 6 cm can be managed with standard fixation and autogenous grafting, while defects over 6 cm require deliberate planning around bone transport, shortening-lengthening, or vascularised fibular grafting.
Do not rely on high limb-salvage scores to dictate amputation — the evidence shows these thresholds are poorly validated, and the functional outcomes of reconstruction versus amputation are equivalent even in the most severe injuries.
A narrative review by Keating et al. (Edinburgh, 2005) synthesising the epidemiology, classification, and surgical management of fractures with significant bone loss — from initial limb-salvage decision-making through definitive skeletal reconstruction — and providing a management algorithm based on defect size, location, and soft-tissue status.
When you encounter an open fracture with bone loss, use defect size as your primary decision branch: defects under 6 cm can be managed with standard fixation and autogenous grafting, while defects over 6 cm require deliberate planning around bone transport, shortening-lengthening, or vascularised fibular grafting.
Do not rely on high limb-salvage scores to dictate amputation — the evidence shows these thresholds are poorly validated, and the functional outcomes of reconstruction versus amputation are equivalent even in the most severe injuries.