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INTRODUCTION

Extensive bone loss due to open comminuted fractures, caused by high velocity accidents associated with trauma are very difficult to treat because of various factors such as:

Loss of bone fragment(s) extruding on the ground during and after accidents.

Infection at the affected and associated sites.

Extensive loss of blood.

Uncertain details about patient.

Inadequate information with the general public about the collection and preservation techniques of loose fragments of bone.

Inadequate processing, sterilization and storage facilities available with the hospitals.

Inadequate bone susbtitutes to fill up extensive bone gap.

Bangkok Biomaterial Center was of the opinion that if loose fragments of bone are collected by anybody from the general public immediately after the accident, put in a plastic bag and brought to a tissue bank, then there would be high possibility of processing the bone through regular process of cleaning, sterilizing with Gamma Ray and storing at -700 . This will allow the fragments to be stored in a time tested system. At the same time, the patient can recover from trauma, and infection at the affected site can be controlled. Once that is done, the Autograft can be conviniently retransplanted into the patient. This information has been distributed by the Bangkok Biomaterial Center to tissue allograft users in Thailand and also to the general public time to time through various sources of public information network.

 

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Mr. L. E, (German) male tourist aged 38 years, was involved in a motorcycle accident on 26th March 2000 just two hours after landing in Thailand at Samui Island. He hired a motor cycle for riding by himself and hit a tree. He had sustained multiple injuries (comminuted open fracture) on his left thigh (shaft of femur). He also had transient loss of consciousness and was taken to the local hospital where first aid was given to him. The diagnosis was comminuted fracture, shaft of left femur with long segment bone loss and intra-articular fracture condyle of femur. During the trauma, two loose fracture of bone fragments (17.5 cm and 13 cm long) of his fractured bone fell outside on the ground and were collected by the onlookers in a plastic bag and sent along with him to the local hospital (Koh Samui Hospital).

This patient was transferred to Bangkok General Hospital, Bangkok by air on 30th March 2000 in the same condition. At the Bangkok General hospital, debridement & Irrigation of wound along with internal fixation of the distal femoral condyle with cancellous screws was carried out. The loose bone fragments were sent over to the Bangkok Biomaterial Center at the Siriraj Hospital, Bangkok with a request to process and sterilize it for re-transplantation. At the Bangkok Biomaterial Center, the autograft (bone from the same individual) fragments were washed in an ultra-sonic bath for 50 minutes with sterile distilled water, placed in plastic bag, wrapped in linen cloth, labeled and irradiation sticker was put on the package. Then this package was vacuum packed and sealed in another layer of plastic bag. Finally the package was sterilized by Gamma Ray with a dose of 25 kGy in frozen state and stored in deep freeze at -700C until 15.00 hrs on 7th April 2000. The bacteriological study was done using washing solution after centrifugation by the bacteriology laboratory. The Bangkok Biomaterial Center has an in-house facility of Gamma Ray irradiation by a Cobalt60 Gamma source provided by International Atomic Energy Agency, Vienna, Austria in 1997. It is the 3rd case of its kind, that the Bangkok Biomaterial Center has provided this service.

The irradiated loose bone fragments were duly packed in a tuffnel box with dry ice (Liquid CO2) and handed over to the patient at the Bangkok General hospital at 15.30 hrs on the 7th April 2000. This autograft was packed in dry ice so that it could be carried along with the patient back to Germany on the same evening for re-transplantation.

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                  X-ray showing severe communication fracture

 

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Split fragments of the loose bone fragment Processed, irradiated, packed and deep frozen bone fragment for retransplantation

                         

                                                                                                 

 

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The packet put in dry ice for transportation to Germany Patient on traction at the hospital

                         

 

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The loose bone fragment handing meeting between the representative of BBC Bangkok General Hospital and patient relative Press conference post handing ceremony

                                        

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Mr. T. K. male aged 34 years a resident of Thailand was involved in a motorcycle accident on 24th December 1998 in Bangkok, Thailand. He had sustained multiple injuries (comminuted open fracture) on his right knee (shaft of tibia). He also had transient loss of consciousness and was taken to the Siriraj hospital where first aid was given to him. The diagnosis was comminuted fracture shaft of right tibia with long segment bone loss and intra-articular fracture condyle of tibia. During the trauma one loose fragment (15cm long) of his fractured bone fell outside on the ground and was collected by the onlookers in a plastic bag and sent along with him to the Siriraj Hospital.

At the Siriraj hospital, debridiment & irrigation of wound along with internal fixation of the distal femoral condyle with cancellous screws was carried out. The loose bone fragments were sent over to the Bangkok Biomaterial Center at Siriraj Hospital with a request to process and sterilize it for re-transplantation. At the Bangkok Biomaterial Center, the autograft (bone from the same individual) fragments was washed in an ultra-sonic bath for 50 minutes with sterile distilled water, placed in plastic bag, wrapped in linen cloth, labeled and a irradiation sticker was put on the package. Then this package was vacuum packed and sealed in another layer of plastic bag. Finally the package was sterilized by Gamma Ray with a dose of 25 kGy and stored in deep freeze at -140oC, until 9.00 hrs on 28th December 1998. The Bangkok Biomaterial Center has an in-house facility of Gamma Ray irradiation by a Cobalt60 Gamma source provided by International Atomic Energy Agency, Vienna, Austria in 1997. This was the2nd case of its kind, that the Bangkok Biomaterial Center has provided this service.

The irradiated loose bone fragments were duly packed in a tuffnel box with dry ice (Liquid CO2) and handed over to the surgeon who was Prof. Yongyudh Vajaradul himself at the Siriraj hospital at 9.30 hrs on the 28th Decemberl1998. This autograft was then retransplanted into the patient.

 

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X-Ray of case No.2 showing fracture with bone loss                   The loose bone fragment

 

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Post Operative X-Ray 6 months                                 Post operative X-ray 1 year

 

 

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