Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 13, Number 8, August 2022, pages 408-413

Traumatic Humeral Diaphysis Extrusion and Replantation With Periosteal Involvement

Figures

Figure 1.
Figure 1. (a) The initial radiograph diagnosing the absence of a 6-inch humeral diaphysis. (b) Extruded fragment of bone present in the hands of emergency department personnel immediately following the MVC.
Figure 2.
Figure 2. Intraoperative fluoroscopic imaging of the patient’s left humerus before autograft replantation of the extruded bone fragment (a) and post-surgical internal fixation of humerus and olecranon (b and c). The images demonstrate the placement of complex internal fixation of the distal humerus and a single fixation screw within the olecranon, with normal articulation intraoperatively.
Figure 3.
Figure 3. Two-month postoperative radiographs of the left humerus (a) and left lateral olecranon fixation (b). There is demonstration of the extensive plate and screw fixation of the full length of humerus traversing the extensive comminuted mid to distal left humeral fracture with mild lateral displacement of the primary distal fracture fragment. There is also partial visualization of screw fixation of the proximal ulnar fracture. Periosteal reaction and bridging bone formation are seen at the fracture sites.
Figure 4.
Figure 4. Five-month postoperative radiographs of an anterior/posterior view (a) and lateral view (b). The patient’s follow-up imaging at 5 months postoperative demonstrated intact internal fixation hardware of a segmented left mid and distal humeral diaphyseal fracture, with a mild interval increase in apex lateral angulation at the distal humeral diaphyseal fracture site but with progressive osseous bridging when compared to previous radiographs.

Table

Table 1. Summary of the Three Cases
 
Name of studyInvolved bonePreparation techniquesResults of implantationOther notes
Traumatic femoral bone loss [1]Large femur fragment (10 inches)Cultured, autoclaved, and treated with betadineNo infection, 2 years later patient walked with a barely noticeable limpNegative for neurovascular injury, intact periosteal sheath and vasculature
Traumatic femoral bone defect reconstruction [6]Large femur fragment (11 cm)Autoclave at 121 °C, for 20 min at 1.3 barsComplete healing of both fracture lines at 2 years follow-upIntact periosteal sheath and vasculature
Head-on allograft transplantation [4]Multiple small femur fragmentsDiscarded fragments, due to the high risk of nonunionAllograft utilizedFar too much fragmentation