Bone Abstracts

Introduction: Bone is a dynamically changing organ. Reduction of mechanical loading on bone inhibits bone formation and accelerates bone resorption. Prolonged immobilization in casts, therapeutic bed rest and application of external fixations to treat fractures are common causes of disuse osteoporosis.

Case Report: We report a case of striking osteoporosis in a 11 years old Syrian boy with a complex open right leg wound following a blast injury (24.03.2013). He presented to ER with compound comminuted fractures of tibia and fibula with bone and soft tissue loss and vascular insult that left his ankle and foot cold and dark blue colored. He underwent immediate surgical intervention where all wounds were debrided thoroughly and a neurovascular repair was carried out after immobilization of fractures with external fixation system (orthofix). Following surgery palpable pulses were present distally but motor and sensory examination could not be obtained. Antibiotics and anti-tetanic therapies were administered. During and after surgery 12 units of PRBC’s and FFP’s were needed to restore normal BP. He was taken to OR four times in the 2 weeks following the initial surgery and underwent debridement of non viable tissues. On 09.04.2013 a cross leg myo-cutaneous flap was executed successfully and was divided 6 weeks later. Patient and his family fled to Lebanon in 10.09.2013 and presented to our OPD viable leg in external fixation device. Plain films and VCT study showed extensive bone tissue loss and loose four pins of the fixation device. The amount of bone lost was quite severe and patient will need aggressive and continuous treatments and his disuse osteoporosis requires a long time to recover.

Discussion: The afflicted extremity spent several months in external fixation device and this lead to striking osteoporosis distal to and including the area of injury. The period of recovery of these cases is several times longer than the period of bone loss and recovery varies widely. Hence, we have to keep in mind that there is no treatment better than prophylaxis of neglected disuse osteoporosis.