FILLING OF A LARGE BONE DEFECT WITH CORTI COSPONGIOUS BONE-GRAFTS AFTER SHOTGUN FRACTURE OF THE FEMUR

The treatment of a 12-cm bone defect after shotgun fracture of the fem ur is described. Semitubular corticospongious bone grafts from both il iac crests, 6 cm long and 0.8 cm wide, were tied into two bundles with an absorbable suture and were laid successively into the diaphyseal d efect. With another absorbable suture the bundles were anchored to the condylar 95-deg plate. Two months later the condylar plate was remove d and an external fixator placed because of inflammation; the bone imp lants survived. By 18 months after the injury the bone defect was cure d, no inflammation was present, and the patient was able to walk with full weight bearing. Four conditions have to be fulfilled in the treat ment of an open comminuted fracture with soft tissue defect: thorough necrectomy, rigid fixation, bone grafting and improvement of the blood supply by means of a microvascular musculocutaneous flap.