J Reconstr Microsurg 2011; 27(6): 383-390
DOI: 10.1055/s-0031-1281520
© Thieme Medical Publishers

Reconstruction of Large Traumatic Segmental Defects of the Femur Using Segmental Allograft with Vascularized Fibula Inlay

Hyder Ridha1 , Jason Bernard2 , David Gateley1 , Martin J. Vesely1
  • 1Department of Plastic and Reconstructive Surgery, St. George's Healthcare NHS Trust, London, United Kingdom
  • 2Department of Orthopaedic Surgery, St. George's Healthcare NHS Trust, London, United Kingdom
Further Information

Publication History

Publication Date:
29 June 2011 (online)

ABSTRACT

Segmental defects of the distal femur following trauma pose a reconstructive challenge. A stable reconstruction capable of withstanding high forces while allowing early mobility is paramount. The Capanna technique of reconstruction combining allograft with vascularized bone graft provides such a construct and has been described for oncological resection. We describe a modified Capanna technique, the “inlay” construct. Three reconstructions were performed for distal femoral segmental loss following trauma. One patient had bilateral reconstructions. Bone defects measuring 11, 9, and 8 cm were reconstructed using a large segmental allograft and free fibular flap inlay assembly. Both patients made uneventful recoveries and achieved full weight-bearing without walking aids 6 months postreconstruction. Range of movement of each knee joint achieved at least 90 degrees of active flexion. We have shown that large segmental traumatic defects of the femur can be successfully reconstructed using segmental allograft with vascularized fibula inlay. This reconstruction provides early mechanical stability, protecting the fibula from fracturing and allowing axial loading of healing bone. The inlay assembly allows a large area of bony contact between allograft and vascularized bone, optimizing bony healing. It is a good alternative to other established techniques of managing significant segmental defects of the distal femur.

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Hyder RidhaM.R.C.S. 

(Eng), Hilltop House, College Lane

Woking, Surrey GU22 0EW, UK

Email: hyder.ridha@googlemail.com

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