Postraumatic diaphyseal bone defects in the upper extremity in children.

Introduction The aim of this study was to evaluate the results achieved in children presenting chronic segmentary bone defects at the humerus or forearm. Methods We retrospectively evaluated nine children, treated between 2005 and 2015, presenting long bone upper extremity fractures that got infected and resulted in segmentary bone defects; all lesions had six or more months from trauma. Seven patients were male and two female. Patient’s age averaged 9.9 years. Four defects were located at the humerus, three at the ulna, and two at the radius. All patients had had previous surgical interventions, averaging 3.7; originating bony defects that averaged 4.5 centimeters. Time between initial trauma and definitive surgery averaged 21.8 months. Results Follow-up averaged 2.2years. Union was achieved in all patients. A cement spacer was used in one case, in another case a free fibular bone graft was used. Two patients with humerus defects had significant shortening. All patients returned to their recreational and sports activities without limitations. Discussion Posttraumatic bone defects are rare in children. We present nine cases with segmentary diaphyseal bone defects localized in humerus, ulna or radius; in eight cases the reconstruction was done combining autogenous bone grafts and plates bridging the defects; achieving union and stability without pain in all cases. Conclusions The combination of different types of bone autograft, various plaques placed bypassing the lesion and the use of the induced membrane technique allowed us to obtain consolidation and return to normal activity in the nine children with segmental bone defects in hummers, ulna or radius.