The Denver Clinic for Extremities at Risk was contacted regarding a young man who was working on an oil rig when a compressor exploded nearby. Both his legs were severely injured, requiring the left leg be amputated at a trauma center in the area where the blast occurred. The right leg was also severely injured but there was an opportunity to save the right leg so the surgeons placed an external fixation device on his leg to best stabilize the fractures.  Physicians at the trauma center requested the patient be transferred to the Bone Healing team.When he arrived at Presebyterian/St. Luke's Medical Center the bone healing team agreed there was a good opportunity to save his right leg.

The patient was taken to the operating room where the external fixator and plate that had been placed on his leg at the trauma center were removed. He underwent a series of operations over the next few days aimed at keeping the wounds as clean as possible. Bone and soft tissue that looked dead or infected was removed.

When the team determined the wounds were clean they placed an antibiotic filled cement spacer in the area of bone loss, fixed this in place with a metal plate, and covered the area with a latissimus muscle flap. He recovered a few days in the hospital then was allowed to go home, using a wheelchair for mobility.

Appearance after fixator removed	Antibiotic cement spacer held by a plate

He returned 5 months later for the second stage of his reconstruction, an allograft bone transplant.  The Denver Clinic for Extremities at Risk works closely with Allosource, a tissue bank in Denver to find appropriate donor tissue for these bone reconstruction procedures.  He was taken to the operating room and cultures of the area were obtained. When the pathology report indicated there was no infection the surgery was completed. The antibiotic spacer was removed and a size matched allograft was placed in the area of missing bone.
 

Intra-operative photo showing the leg opened to remove the cement spacer

The following pictures were taken during the operation when the allograft bone was used.  The allograft was first cut to match the patient's tibial deficit.  Then it was placed in the defect created when the spacer has been taken out. A plate was placed on both sides of the allograft to hold it into place, then the incision is closed.

He was able to slowly increase weight bearing through his leg, at the same time he was going through rehabilitation to learn to use a below knee prosthesis on the right.  His x-rays 7 months after the allograft procedure, and 1 year after the original injury show the allograft being incorporated to the native bone on his right leg. 

X-ray 1 year after the original injury.

The patient was able to return to work for the drilling company where he worked at the time of the accident.  He is able to walk without crutches and is able to run after his young son.