R. Komadina et al., FILLING OF A LARGE BONE DEFECT WITH CORTI COSPONGIOUS BONE-GRAFTS AFTER SHOTGUN FRACTURE OF THE FEMUR, Der Unfallchirurg, 99(9), 1996, pp. 701-703
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.