Consultant, Orthopaedics & Joint Replacement, Artemis Hospital, Gurgaon
Part 11 of 12 in Spectrum of Orthopaedic Disorder - Evaluation and Management
Reconstructing Severe Trauma: Distraction Osteogenesis for Bone and Limb Loss
September 6, 2026
Some of the most severe cases in Dr. Rohit Lamba's Jivo Masterclass session were not fractures that had gone wrong, but injuries where a genuine part of the limb, bone, soft tissue, or both, was destroyed outright. Two such cases, a blast injury to the elbow and a case of major bone loss, show how reconstruction is staged when the damage goes well beyond a broken bone.
A blast injury to the elbow, after the hand was already lost
One patient arrived with a blast injury that had already cost him his hand, amputated at the time of the original injury, and left his elbow shattered. Dr. Lamba's team addressed it in two stages: first an external fixator paired with a flap cover to close the wound and protect the exposed bone, then, in a second operation, a fusion of the elbow joint itself. Fitted afterward with an artificial prosthesis, the patient regained enough function to hold a pen and write.
Regrowing bone that has been lost outright
The second case involved an injury of the kind Dr. Lamba told his audience to expect in war injuries, blasts or serious accidents: a large section of bone missing altogether, not merely broken. Reconstruction here relied on an external fixator and distraction osteogenesis, a technique that gradually stimulates new bone to form and fill the gap left by the missing segment. The patient went on to stand, walk and return to his usual work on the reconstructed limb.
This article is based on a Jivo Masterclass session conducted by Dr. Rohit Lamba, Consultant, Orthopaedics & Joint Replacement, Artemis Hospital, Gurgaon. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Rohit Lamba taught doctors across Africa on April 6, 2025.
FROM THE LIVE Q&A
Moderator
Which group of patients is hip replacement surgery indicated for?
Dr. Rohit Lamba
Dr. Lamba outlined four categories. The first is congenital deformity, such as developmental dysplasia of the hip, where the hip is out of the socket from birth. The second is a childhood infection, Perthes disease, or a slipped epiphysis that reshapes the hip and leads to arthritis later in life. The third is avascular necrosis that has reached an advanced, arthritic stage in early adulthood. The fourth is a hip fracture that has not united properly, healing in a poor position that causes arthritis and pain.
Frequently Asked Questions
Is there a definitive treatment for arthritis?▼
Dr. Lamba answered on the assumption the question was about rheumatoid arthritis, since a network issue had cut off part of the question. In the early stage, before the cartilage is damaged, it can be managed well with disease-modifying antirheumatic drugs (DMARDs); cases that do not respond well can move to biological disease-modifying drugs, but only after full evaluation by an orthopaedic surgeon or rheumatologist. Once the cartilage is already damaged, the definitive treatment is hip replacement, and with current implants a patient can expect to stay pain-free and active for the next 30 to 35 years.
Which group of patients is hip replacement surgery indicated for?▼
Dr. Lamba outlined four categories. The first is congenital deformity, such as developmental dysplasia of the hip, where the hip is out of the socket from birth. The second is a childhood infection, Perthes disease, or a slipped epiphysis that reshapes the hip and leads to arthritis later in life. The third is avascular necrosis that has reached an advanced, arthritic stage in early adulthood. The fourth is a hip fracture that has not united properly, healing in a poor position that causes arthritis and pain.
How is a blast injury with major bone loss treated?▼
Treatment is typically staged: an external fixator and a flap cover close the wound and protect exposed bone first, with reconstructive steps such as joint fusion carried out afterward.
What is distraction osteogenesis?▼
It is a bone reconstruction technique using an external fixator to gradually stimulate new bone growth across a gap left by a missing or destroyed section of bone.
Can patients recover meaningful function after this kind of trauma?▼
Dr. Lamba's cases showed patients regaining real function afterward, including one who returned to walking and work, and another who, fitted with a prosthesis after losing a hand, was able to write again.
In This Series: Spectrum of Orthopaedic Disorder - Evaluation and Management
- 1.Spectrum of Orthopaedic Disorders
- 2.Understanding the Main Causes of Knee Arthritis
- 3.How Robotic and Computer-Navigated Systems Are Used in Joint Replacement
- 4.Developmental Dysplasia of the Hip: Treating a Childhood Hip Problem
- 5.Perthes Disease: When Childhood Hip Damage Surfaces Years Later
- 6.Avascular Necrosis of the Hip: Causes, Stages and Treatment
- 7.Hip Replacement and Sickle Cell Disease: Why Blood Transfusion Comes First
- 8.When Is Hip Replacement the Right Treatment?
- 9.ACL and Ligament Reconstruction: Grafts and When Surgery Is Needed
- 10.Treating Fracture Non-Union and Bone Infection with External Fixators
- 11.Reconstructing Severe Trauma: Distraction Osteogenesis for Bone and Limb Loss
- 12.Vitamin D Deficiency in Children: When Rickets Requires Corrective Knee Surgery