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Establishment of a Segmental Femoral Critical-size Defect Model in Mice Stabilized by Plate Osteosynthesis
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Secondary Union of a Critical Segmental Femoral Defect: A Case Report
Elizabeth Davis1, Krishna C Vemulapalli, Denise Hansen
1Department of Orthopedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
JBJS Case Connector
|November 16, 2018
Summary
Unusual secondary bone healing occurred in a patient with a large femoral defect after a motorcycle accident. This case highlights potential biological and mechanical factors influencing fracture union in complex cases.
Area of Science:
- Orthopedic surgery
- Trauma care
- Bone regeneration
Background:
- Open femoral shaft fractures with significant segmental bone loss present complex treatment challenges.
- Achieving union in large bone defects often requires advanced reconstructive techniques.
Observation:
- A 41-year-old male sustained an open femoral shaft fracture with 10 cm segmental bone loss from a motorcycle collision.
- Initial treatment involved irrigation, debridement, and intramedullary nailing.
- The patient was lost to follow-up and presented 9 months post-injury with abundant callus formation.
Findings:
- A simple hypertrophic nonunion was diagnosed at 11 months post-injury.
- The nonunion was successfully treated with exchange nailing.
- The case demonstrated an unusual instance of secondary union in a large segmental femoral defect.
Implications:
- This case suggests that secondary union of large segmental femoral defects, while uncommon, is possible.
- Potential contributing factors include fracture site biology, intramedullary reaming effects, and fixation mechanics.
- Further research is needed to elucidate the mechanisms underlying spontaneous union in such severe injuries.
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