Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
J Med Case Rep. 2023 Oct 13;17(1):452. doi: 10.1186/s13256-023-04193-5.
Gustilo-Anderson type IIIc tibial open fracture with large bone defects in elderly patients with severe osteoporosis is a rare injury that may be a challenging clinical scenario.
This study presents the case of a 68-year-old Japanese man who sustained a Gustilo-Anderson type IIIc open tibial fracture with a large bone defect. The patient had severe osteoporosis and the bone was contaminated; therefore, we determined that the bone could not be returned to the tibia. The patient underwent acute limb shortening and gradual lengthening with an Ilizarov external fixator combined with low-intensity pulsed ultrasound and teriparatide administration for limb reconstruction, which allowed immediate full weight-bearing capacity. The fixator was removed at 12 months postoperatively, and by this time, the fracture had completely healed. At the most recent 5-year follow-up after the injury, the patient reported full weight-bearing capacity without walking aids and had full knee and ankle range of motion.
To the best of our knowledge, this is the first study to report the use of combined Ilizarov technique, low-intensity pulsed ultrasound, and teriparatide for limb reconstruction of Gustilo-Anderson type IIIc open tibial fractures with large bone defects in elderly patients with severe osteoporosis.
老年严重骨质疏松合并 Gustilo-Anderson Ⅲc 型胫骨开放性骨折伴大骨缺损较为罕见，可能是极具挑战性的临床情况。
本研究报告了 1 例 68 岁日本男性患者，其发生 Gustilo-Anderson Ⅲc 型开放性胫骨骨折伴大骨缺损。患者患有严重骨质疏松症且骨质污染严重，我们判断胫骨无法复位。患者接受急性肢体短缩和逐步延长治疗，采用 Ilizarov 外固定架联合低强度脉冲超声和特立帕肽治疗进行肢体重建，可立即实现完全负重。术后 12 个月时拆除固定架，此时骨折完全愈合。损伤后 5 年的最近随访时，患者报告可完全负重，无需助行器，膝关节和踝关节活动度完全。
据我们所知，这是首例报道在老年严重骨质疏松合并 Gustilo-Anderson Ⅲc 型胫骨开放性骨折伴大骨缺损患者中，采用 Ilizarov 技术联合低强度脉冲超声和特立帕肽进行肢体重建的研究。
