Reimplantation of a traumatically expelled tibial diaphysis

The successful reimplantation and healing of a traumatically expelled tibial diaphysis in a 16-year-old boy is presented. Radionuclide scintimetry with 87mSr and 85Sr during the following months showed a pronounced diaphyseal activity corresponding to abundant periosteal bone formation around the dead cortical bone, increased activities over the fractures and the growth plates. Microscopical investigation after tetracycline labelling about 1 year after the accident showed a pronounced osteoblastic and osteoclastic activity in the superficial part of the cortex of the reimplanted bone. The endosteal part consisted of necrotic bone and was only to a small extent replaced by new bone. The uncomplicated healing process observed in this case can be attributed to the youth of the patient, the absence of infection and, most important of all, the preservation of the periosteum and its blood supply.