Composite Bone and Soft Tissue Loss Treated With Distraction Histiogenesis


The purpose of this article is to describe the use of shortening and angulation to manage composite bone and soft tissue loss associated with combat-related type IIIB open tibia fractures. Four patients underwent placement of a software-driven circular fixator with acute shortening and angulation to manage composite bone and soft tissue loss. Frames were applied using the Rings First Method, and an induced deformity was created with the soft tissue defect within the concavity. Distraction histiogenesis was utilized to restore limb length and regenerate soft tissues. Three patients had healed fractures and mature regenerate allowing frame removal, while one remained in his frame for further consolidation. Mechanical alignment and limb length were restored in all patients. No major frame adjustments were required and all distracted soft tissues healed without complication. The article concludes that composite bone and soft tissue loss is effectively managed with distraction histiogenesis and the use of a software-driven circular fixator. (Journal of Surgical Orthopaedic Advances 19(1):23–28, 2010)


CPT Michael J. Beltran, MD, CPT Leah M. Ochoa, MD, MAJ Richard M. Graves, MD,
MAJ(P) Joseph R. Hsu, MD, and the Skeletal Trauma Research Consortium

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