Thankappan Ajayakumar, Nasimudeen Nizaj, Rangarajan Aadithya
Apollo Adlux Hospital, Kochi, Kerala, India.
J Clin Orthop Trauma. 2025 Apr 28;67:103037. doi: 10.1016/j.jcot.2025.103037. eCollection 2025 Aug.
Type III Gustilo-Anderson fractures with massive bone loss present significant treatment challenges due to the extensive bony and soft tissue damage they entail. Poor management can lead to complications such as osteomyelitis, non-union, limb length discrepancies, or even amputation. We present two cases of 52- and 56-year-old adults who had complex intra-articular distal femur open fractures with massive bone loss of 21 cm and 18 cm, respectively, successfully managed using synthetic calcium sulfate beads and vascularized fibula grafting. The use of calcium sulfate offers several advantages over polymethylmethacrylate (PMMA) beads, including more effective antibiotic delivery, greater osteogenicity, and reduced systemic toxicity of antibiotics. We recommend the use of calcium sulfate over PMMA in managing complex cases with bone defects.
III型 Gustilo-Anderson 骨折合并大量骨质缺损因其所导致的广泛骨与软组织损伤而带来显著的治疗挑战。处理不当可引发诸如骨髓炎、骨不连、肢体长度差异甚至截肢等并发症。我们报告两例分别为52岁和56岁成年人的病例，他们患有复杂的股骨远端关节内开放性骨折，骨质缺损分别达21厘米和18厘米，通过使用硫酸钙人工骨珠和带血管腓骨移植成功得到治疗。与聚甲基丙烯酸甲酯（PMMA）骨珠相比，硫酸钙的使用具有多个优势，包括更有效的抗生素递送、更强的成骨性以及抗生素全身毒性降低。在处理伴有骨缺损的复杂病例时，我们推荐使用硫酸钙而非PMMA。
