Reimplantation of a Large Extruded Segment of Bone in an Open Fracture

Replacing an extruded segment of bone in an open fracture imposes a challenging decision
concerning the best and safest patient management. There are numerous advantages to
restoring the patient’s own extruded bone segment to its original location, particularly when
the bone segment is of structural importance. However, reimplantation of contaminated and
avascular extruded bone segments can potentially result in serious infection or nonunion.
There is no conclusive evidence regarding the best decontamination protocol for the safest use
of the recovered bone segment as an autologous graft. Among the different chemical sterilization
solutions 10% povidone-iodine and chlorhexidine gluconate solutions are the author’s
most preferred solutions. Regarding cellular toxicity, 10% povidone-iodine has been found to
be the most favorable among the readily available solutions.