Evidence map›Paper›PMID 40475840›Full record

ArticleJournal of clinical orthopaedics and trauma2025

Management of open femur fractures with massive bone loss using two-stage vascularized fibula grafting and synthetic calcium sulfate: A report of two cases.

Ajayakumar Thankappan, Nizaj Nasimudeen, Aadithya Rangarajan

Abstract readCase Reports
In one paragraph

Article in Journal of clinical orthopaedics and trauma, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Ajayakumar ThankappanApollo Adlux Hospital, Kochi, Kerala, India.
Nizaj NasimudeenApollo Adlux Hospital, Kochi, Kerala, India.
Aadithya RangarajanApollo Adlux Hospital, Kochi, Kerala, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Type III Gustilo-Anderson fractures with massive bone loss present significant treatment challenges due to the extensive bony and soft tissue damage they entail. Poor management can lead to complications such as osteomyelitis, non-union, limb length discrepancies, or even amputation. We present two cases of 52- and 56-year-old adults who had complex intra-articular distal femur open fractures with massive bone loss of 21 cm and 18 cm, respectively, successfully managed using synthetic calcium sulfate beads and vascularized fibula grafting. The use of calcium sulfate offers several advantages over polymethylmethacrylate (PMMA) beads, including more effective antibiotic delivery, greater osteogenicity, and reduced systemic toxicity of antibiotics. We recommend the use of calcium sulfate over PMMA in managing complex cases with bone defects.

Indexed as

Bone lossCalcium sulfateFibula transplantationFracturesInduced membraneInfectionOpenPathologic

Identifiers

PMID40475840
PMCPMC12136910

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.