Strength of youth: conservative treatment of segmental bone defect in children

Healing of a Large Bone Defect Secondary to Tuberculosis in an Infant: A Case Report

CASE

A 9-month-old male child presented with swelling over the distal radius that was debrided, and histopathology revealed tuberculosis. Curettage left a large bony defect in the distal radius metaphysis. The defect was not surgically addressed because near-complete spontaneous filling of the defect was seen at 3 months' follow-up. The patient was given antituberculous therapy for 12 months and had excellent outcomes at 24 months' follow-up.

CONCLUSION

A large bony defect secondary to tuberculosis, in the distal radius metaphysis in an infant, regenerated spontaneously without the need for bone substitutes, bone grafting, or complex microvascular procedures.

Spontaneous healing of a traumatic critical radius bone defect in adolescent: A rare case report

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Osteogenesis in fracture requires osteogenic cells, osteoconductive components, and osteoconductive scaffold.

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Intact periosteum and sufficient soft tissue perfusion could be biologically required.

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Pediatric patient with significant bone defect is able to heal the defect speontaneously.

Introduction and importance

Fracture with a critical bone loss is associated with a profound burden of disease impact. Although there are several options exist for its treatment, but still those reconstructive procedures are technically demanding, relatively expensive and sometimes the result is less than what was expected. The objective of this study is to report a rare case of spontaneous healing of a critical radial bone defect in an adolescent.

Case presentation

We reported a 15 year old boy with a segmental open fracture of left radius, open fracture of left distal shaft ulna and closed fracture of left intercondylar humerus. The middle fragment of a fractured radius was extruded out, pulled out and then thrown away by his parent. Debridement, open reduction, and internal fixation for ulna were performed as well as reposition and internal fixation for the intercondylar humerus fracture. The plan was to wait until the ulnar fracture and intercondylar fracture to heal without any sign of infection and proceed to overcome the radial critical bone defect. This case report had been reported in line with SCARE criteria. The patient showed up seven months later with solid union of the critical radius bone defect and fully functioning hand with only slight limitation in pronation.

Clinical discussion

Osteogenesis in fracture requires osteogenic cells, osteoinductive components, osteoconductive scaffold, and stability. Despite the fact that critical bone defect poses great challenge for its management, intact periosteum and sufficient soft tissue perfusion were able to provide those biologic requirements adequately for fracture healing and ensure spontaneous healing of a traumatic critical bone loss in adolescent without any reconstructive procedure.

Conclusion

Spontaneous healing in critical bone defect is possible, provided all the favorable factors present to support this phenomenon.