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Orthopaedic trauma

Complex Fractures with Bone Loss

OVERVIEW

Complex fractures with bone loss represent a challenging category within orthopaedics. These fractures involve a break in the bone that is further complicated by a loss of bone tissue. Such injuries often demand a nuanced approach due to the compromised structural integrity of the affected bone.

Types of complex fractures with bone loss:

  1. Angular malunion: The bone heals with an angular deformity, causing misalignment along the axis.
  2. Rotational malunion: This occurs when the bone twists during the healing process, leading to functional limitations.
  3. Shortening malunion: The bone heals with a length discrepancy, affecting limb function and overall biomechanics.

Causes of complex fractures with bone loss:

  1. High-impact trauma: Motor vehicle accidents, falls from height, and sports injuries can generate the force required to cause complex fractures with bone loss.
  2. Gunshot or stab wounds: Penetrating injuries can create fractures with bone loss, particularly when the projectile or weapon causes extensive damage to the bone.
  3. Infection: In some cases, infections affecting the bone (osteomyelitis) can weaken the bone structure, making it more susceptible to fractures and subsequent loss.
SYMPTOMS
  • Severe pain: Patients often experience intense pain at the site of the fracture, exacerbated by movement.
  • Deformity or instability: The affected limb may appear deformed, and there may be noticeable instability or abnormal movement.
  • Swelling and bruising: Immediate swelling and bruising around the fracture site are common indicators.
TREATMENT
Dr du Plessis employs a comprehensive approach to treating complex fractures with bone loss, tailoring interventions to each patient's unique circumstances.

Conservative treatment:
  • Immobilization: Casting or bracing may be employed to restrict movement and facilitate healing.
  • Medication: Pain management and anti-inflammatory medications can alleviate discomfort and aid in the healing process.
SURGERY
  • Bone grafting: To replace lost bone tissue, Dr du Plessis may perform bone grafting procedures using autografts or allografts.
  • Internal fixation: Surgical methods like the insertion of plates, screws, or rods may be necessary to stabilize the fracture and support bone healing.
  • External fixation: In certain cases, external devices may be used to stabilize the fracture externally.

FAQ

How does internal fixation contribute to the treatment of complex fractures?
Internal fixation involves the surgical placement of plates, screws, or rods to stabilize the fractured bone, facilitating proper healing.
When is external fixation used in the treatment of complex fractures?
External fixation involves the use of devices outside the body to stabilize the fracture. It may be employed in specific cases where internal fixation is not suitable.
What is the expected recovery time for patients with complex fractures with bone loss?
Recovery times vary based on the severity of the fracture, the chosen treatment approach, and individual patient factors. Dr du Plessis develops personalized recovery plans for each patient to optimize their healing process.

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    PUBLICATIONS

    Assessment of the Reliability and Reproducibility of the Langenskiöld
    Classification in Blount’s Disease

    DU PLESSIS J, Firth GB, Robertson A. Assessment of the reliability and reproducibility of the Langenskiöld classification in Blount's disease. Journal of Pediatric orthopedics. Part B. 2019 Nov 12.

     

    The Impact of the COVID-19 lockdown restrictions on orthopaedic trauma admissions in a central academic hospital in Johannesburg

    Foster M, Du Plessis J, Jansen van Vuuren M, Jingo M, Pietrzak JR. The impact of the COVID-19 lockdown restrictions on orthopaedic trauma admissions in a central academic hospital in Johannesburg. SA Orthopaedic Journal. 2022;21(2):70-5.

    Short term results following two stage revision for periprosthetic joint infection

    DU PLESSIS, J et al. Short-term results following two-stage revision for periprosthetic joint infection. South African Orthopaedic Journal, [S.l.], v. 19, n. 2, p. 64-69, may 2020

     

    Comparison of visual estimations of distal radius fracture radiographic parameters between different levels of orthopaedic doctors.

    Naidoo V, Milner B, du Plessis J. SA Orthop J. 2025;24(1):26-31. http://dx.doi.org/10.17159/2309-8309/2025/v24n1a4