Emergency management of severe bone losses in limb trauma linked to damage control

Bone defect occurrence in the limbs is a very severe complication after high-energy traumas treated with Damage Control Management. This type of complication is included in trauma scores such as ISS (injury Severity Score). Nevertheless, what to do, in emergency management is still controversial from maintaining leg length and the bone defect that will need secondary reconstruction, to acute shortening deleting the bone defect creating some limb length discrepancy that will need secondary lengthening by different methods. From a pluricentric retrospective study of 70 patients treated by maintaining the traumatic limb length, filling the bone defect by a cement spacer, all major technical aspects to obtain a successful outcome are presented. Results from others studies devoted to acute shortening with secondary lengthening, or vascularised bone grafts have shown limits of acute shortening based on defect size, and vascular impairment after shortening. Skin coverage around the bone defect is a major contribution to reconstruction technique choices. Of value to compare the techniques healing time, and number of procedures to obtain fusion. All advantages and pitfalls of different techniques are discussed and compared to help surgeons choosing the best option. Best results are obtained and available in all cases with the cement spacer technique and secondary bone reconstruction.