Reconstruction of bone with severe extremity trauma*

EF: external fixation; IF: internal fixation.
* Severe trauma includes those with multiple other injuries, which may include other fractures, associated extremity injury (vascular, soft tissue, nerve), or other organ system injuries.
¶ Includes either direct skin closure, skin grafting, or tissue flap coverage.
Δ Issues related to the skin, such as severe swelling leading to formation of blisters, or ischemic changes potentially leading to areas of skin necrosis.
◊ Repeated attempts to control infection, revascularize, or cover a wound, while rare, can occur. In such cases, amputation may be necessary.
§ Vascularized bone grafting and bone transport each have advantages and disadvantages. For upper extremity reconstruction, vascularized bone grafting is often chosen rather than bone transport since early weight bearing (the greatest advantage of one transport) is not needed. However, for surgeons who do not perform microsurgery, bone transport is the better option.