Complex Bone Reconstruction

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What is complex bone reconstruction?

Complex bone reconstruction is an advanced procedure utilising multiple surgical techniques in the restoration of severely damaged bone. The nature of these techniques is determined by the extent of bone loss and available bone stock, local soft-tissue quality and desired functional outcomes.

Indications and contraindications for complex bone reconstruction.

Complex bone reconstructiont is typically employed for the treatment of::

Severe trauma: accompanied by extensive bone damage or loss.

Nonunion or malunion: where bone has failed to heal or where healed bone has developed a deformity or shortening.

Bone infection: where infection has resulted in substantial bone loss.

Tumours or cysts: where tumour resection has resulted in bone loss or defect.

Congenital deformity: where function is severely impaired by deformity or shortening.

Contraindications for complex bone reconstruction include:

Poor general health, including uncontrolled diabetes, immune compromise and severe cardiovascular disease.

Active infection (local or general).

Vascular insufficiency, including avascular necrosis.

Benefits and complications of complex bone reconstruction

Benefits

Restoration of structural integrity.
Improved joint alignment and stability
Reduction in painful symptoms
Prevention of degenerative changes

Known complications

Permanent nerve damage resulting in sensory or motor deficits.
Superficial or deep infection
Vascular injury and bleeding.
Pain.
Hardware breakage and loosening
Deep Vein Thrombosis (DVT)
Reduced joint range of motion

The surgery

The procedures utilised during complex bone reconstruction can include:

Bone grafting: in which bone gaps are filled with donor bone from your own body (e.g., from the iliac crest, tibia or heel bone, or from a donor, or a synthetic substitute in ceramic, metal or polymer. Calcium-based material will be resorbed and replaced with your own bone over time.

Deformity correction: utilising osteotomy and internal or external fixation.

Bone lengthening: utilising distraction osteogenesis to promote new bone growth in the gap, acheiving an overall length increase.

Bone transport: wherein healthy bone is distracted to increase its length and defects are closed simultaneously.

Vascularised bone graft: wherein a segment of the fibula, along with its blood supply is harvested from the lower leg and transplanted to the site of reconstruction.

Stem cell therapy: wherein stem cells from the patient are used to stimulate bone regeneration and healing.

Bone morphogenetic protein (BMP) therapy: wherein these growth factors are injected into the body to induce bone formation.

Internal fixation: wherein plates and screws, or an intramedullary nail, are used to stabilise fractures

External fixation: wherein circular external fixation, using rings connected by rods, or unilateral external fixation, using a single rod or frame, is used to stabilise and align fractures, deformities or distracted bone.

Preparation prior to surgery

You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.
Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility.

On the day of the surgery

You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
The surgical site will be prepared.
You will be administered general or spinal anaesthesia.
An incision will be made over the target area.
Dead or severely damaged bone will be removed.
A fixation device will be fitted and any voids filled by graft.
X-rays are taken to confirm positioning.
Additional soft tissue reconstruction may be carried out if indicated.
The wound will be sutured, dressed and immobilised as required. Vacuum assisted wound closure may be neccessary in the case of significant soft tissue compromise or infection.

After your surgery

In-patient care: you will remain in hospital for several days for monitoring and early-stage rehabilition.
Pain and swelling: You may experience mild to moderate pain. You will be prescribed painkillers to manage these symptoms. Inflammation can be controlled by icing (15 minutes per hour maximum) and elevation.
Mobilising: you may be fitted with a cast or splint after your surgery. How long it remains in place will be determined by the nature of your procedure and your recovery. You will be unable to weightbear during this period. Once weightbearing is indicated, you can begin gradually, using crutches, boots or brace protection, under clinical supervision.
Aftercare: at one week post-surgery, you will be required to attend a wound check and at two weeks your sutures will be removed and further x-rays may be taken. At 6 weeks, you will undergo further X-rays to assess healing, and at three months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing.
Physiotherapy: you recovery will be supported by a tailored physiotherapy protocol.

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000