Autologous grafts of double-strut fibular cortical bone plate to treat the fractures and defects of distal femur： a case report and review of literature

作     者：CHEN Xu LI Jian-jun KONG Zhan YANG Dong-xiang YUAN Xiang-nan 

作者机构：Department of Orthopaedics Shengjing Hospital ofChina Medical University Shenyang 110004 China 

出 版 物：《Chinese Journal of Traumatology》 (中华创伤杂志（英文版）)

年 卷 期：2011年第14卷第4期

页      面：241-246页

学科分类：090603[农学-临床兽医学] 0403[教育学-体育学] 1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 09[农学] 0906[农学-兽医学] 10[医学] 

主　　题：Femur Transplantation, autologous Bone screws 

摘      要：We reported a 23-year-old man who was involved in a high-speed motorcycle accident. He sustained a closed fracture at the right distal femur. The primary fracture happened on February 2008. He underwent open reduction and internal fixation with cloverleaf plate. And one hundred days after the surgery, the proximal screws were pulled-out, but the bone union was not achieved. Treatment consisted of exchanging the cloverleaf plate with a locking compression plate and using an auto-iliac bone graft to fill the nonunion gap. In July 2009, the patient had a sharp pain in the right lower limb. The X-ray revealed that the plate implanted last year was broken, causing a nonunion at the fracture site. Immediately the plate and screws were removed and an intramedullary nail was inserted reversely from the distal femur as well as a 7 cm long bone from the right fibula was extracted and longitudinally split into two pieces to construct cortical bone plates. Then we placed them laterally and medially to fracture site, drilled two holes respectively, and fastened them with suture. We carried on auto-iliac bone grafting with the nonunion bone grafts. The follow-up at 15 months after operation showed that the treatment was successful, X-ray confirmed that there was no rotation and no angular or short deformity. We briefly reviewed the literature regarding such an unusual presentation and discussed in details the possible etiology and the advantages of autologous double-strut fibular grafts to cope with such an intractable situation.