Complex bone reconstruction is a highly advanced surgical procedure that involves techniques to restore severely damaged bones. It usually combines a variety of procedures tailored to a specific patient’s needs, based on the extent of bone loss, available bone stock, quality of adjacent soft tissue envelope, presence of infection, vascular supply, sensory disturbance as well as functional level and patient’s expectations.
Reconstruction of large bone defects and deformities after bone tumour resection, severe trauma with bone loss or extensive bone infection often necessitates removal of a large portion of the bone (to eliminate abnormal bone tissue) and its reconstruction comprising of bone regenerative techniques, bone grafts, artificial implants to reestablish adequate bone stock and restore limb function.
Complex bone reconstruction is recommended when conventional treatments prove insufficient to restore bone integrity. Common indications include:
Not every patient is a suitable candidate for complex bone reconstruction.
By restoring bone stock, proper alignment and stability in patients with severe bone damage, there is a potential chance to improve their mobility, function, and quality of life. However, bone reconstruction is a difficult and engaging process both for the patient as well as the medical team. Recovery can take several months to years and commitment to rehabilitation as well as follow-up appointments is essential for optimal outcomes.
Some of the common types of complex bone reconstruction procedures include:
Bone Grafting is a procedure of filling the gap in a bone with bone from another source
Deformity within the bone or around the joint needs to be corrected with acute or gradual techniques to adjust the mechanical axis of the reconstructed limb [refer to the chapter on deformity correction].
In case of a bone shortening or a significant bone defect, procedures to grow new bone are employed [refer to the chapter on limb lengthening].
Bone lengthening, bone transport or deformity correction can be performed using a variety of instruments such as motorised nails, external fixator devices or circular frames.
A segment of the fibula, along with its blood supply is harvested from the patient’s lower leg and is transplanted to a site requiring reconstruction. This technique is often used in cases where large bone defects need to be addressed.
The above techniques for bone reconstruction need to be supplemented with a range of bone fixation techniques:
Each type of complex bone reconstruction procedure is chosen based on the specific condition, location, and severity of the bone defect. Surgeons work closely with patients to determine the most suitable approach that will offer the best chances of successful bone restoration and recovery.
In many cases, bone reconstruction needs to be combined with soft tissue reconstruction to provide adequate soft tissue coverage for better healing, or with muscle transfers for better function.
If patients are worried about their level of pain, experience significant bleeding, or notice fever or redness around the surgical site, they should contact the office immediately. If assistance is needed after hours, patients can contact the hospital where the surgery was performed, and they will contact Professor Al Muderis on their behalf.
Norwest Private Hospital: (02) 8882 8882
Macquarie University Hospital: (02) 9812 3000