Spontaneous healing of large femoral cortical bone defects: does genetic predisposition play a role?

Traumatic segmental femoral defects are commonly high velocity injuries and their reconstruction necessitates challenging surgical procedures. These injuries present commonly as open fractures and thorough wound debridement followed by adequate soft tissue cover is mandatory before skeletal reconstruction can be commenced. The definitive reconstructive procedure is therefore often delayed and the optimal treatment option is frequently determined by the extent of the cortical defect. The complication rate is high and femoral non-union is not uncommon in these injuries but associated head injuries as part of a polytrauma can have a positive effect on fracture healing. We are presenting a series of four cases, in which traumatic segmental femoral defects of 6, 9, 10 and 15 cm without associated head injury healed spontaneously while the patients were waiting for a definitive skeletal reconstructive procedure.