The treatment of high-energy open fractures is challenging, due to the high rates of infection and delayed or non-unions. The severity of this situation is compounded when bone fragments are traumatically extruded creating a large bony defect. If a large bone segment is lost, reconstruction may be achieved by gradual distraction osteogenesis procedures [1] or by implantation of large cadaveric allografts or vascularized autografts [2]. When the extruded bone segment is brought in with the patient however, the surgeon needs to decide whether to re-implant the extruded segment or not. Furthermore, if the decision for re-implantation is made, how should it be sterilized and when should it be re-implanted. Due to the relative rarity of this scenario, clear protocols regarding sterilization, fixation, and re-implantation steps and techniques of extruded bone segments do not exist [3, 4]. Therefore, sharing our individual experiences with dealing with such devastating scenarios in the surgical community may help in the formation of protocols and guidelines pertaining to this condition.
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