Reconstruction of Juxta-Articular Bone Defect in an Infected Fracture Distal Right Femur Using Autologous Fibular Strut and Iliac Crest Graft

Abstract

Distal femur fractures are about 7 % of all femur fractures.1 Being complex in nature management of these fractures is difficult; management is still a challenge in this technically advanced era. Fibular strut graft is one of the useful and simple options to manage defects in distal femur fractures. High velocity injuries causing open fractures may lead to infection and non-union of fracture if proper debridement and antibiotics are not used as per established protocol. Antibiotics can be given mixed with polymethyl-methacrylate (PMMA) cement formed in beads at the open fracture site or coated over a nail.2 This causes slow release of antibiotics and helps in control of infection. Local infection, damaged soft tissue, ischemia over fracture site, stabilisation of fracture, the hardware used and patient’s co morbidities all play a role in union and infection control of open fractures. Early detection of infection is important to avoid non-union and related complications. Distal femur juxta-articular fracture may develop infection due to fractures and unstable fixation more commonly. This may result in cavity formation and complications like osteomyelitis often leading to bone destruction and sequestrum formation. Its management becomes a challenging task for an orthopaedic surgeon.3- 9 The reconstructive methods are autogenous cortical bone, cancellous bone, allograft, bone substitutes like synthetic bone blocks and bone granules. Free bone transfer is crucial in reconstructing massive defects in distal femur fracture due to properties of rapid healing and being hypertrophic.7-13 Fibula is the best available option for grafting in massive defects of femur due to its characteristics like mechanical strength, length, minimum morbidity, and resistance to infection.3,11,13 A single fibula strut graft can give up to 26 cm of graft. The case reported here is of a patient of juxta-articular bone defect in an infected previously operated fracture distal femur using autologous fibular strut and iliac crest graft