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Reimplantation of an Extruded Humeral Segment into an Intact Periosteal Envelope in a ChildA Case Report
Kyeong-Jin Han, MD1; Nam-Su Chung, MD1; Hyo Sung Lee, MD1; Yu Sang Lee, MD1
1 Department of Orthopaedic Surgery, Ajou University School of Medicine, Youngtong-gu, Wonchon-dong, Suwon, 443-721, South Korea. E-mail address for Y.S. Lee: osdrlee@gmail.com
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Investigation performed at the Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2012 Sep 12;2(3):e48 1-6. doi: 10.2106/JBJS.CC.K.00149
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Traumatic bone extrusion followed by successful bone-segment reimplantation is uncommon1-4. When bone loss is minimal, open fractures may heal by stabilization alone, and small amounts of bone loss can generally be treated with an autogenous or allogenic bone graft. Large segmental bone defects may occur at the time of injury or after surgical debridement of devitalized bone, and may require large grafts, multiple grafts, vascularized bone grafts, or bone transport5-7. The benefits of reimplanting an extruded segment include maintenance of the original skeletal structure, avoidance of morbidity associated with autogenous bone harvesting, and avoidance of allograft bone procedures or prolonged bone transport procedures. Regardless of the sterilization method used, reimplantation of a devascularized bone segment after meticulous wound debridement and sound bone stabilization is associated with an elevated risk of infection. However, the literature lacks guidelines regarding the sterilization, timing of reimplantation, and stabilization of extruded bone segments1-4. We describe a case of early reimplantation of an extruded humeral segment in a child. The patient and her family were informed that data from this case would be submitted for publication, and they provided consent.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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