Überbrückung eines ausgedehnten Knochendefekts mit kortikospongiösen Transplantaten bei Femurfraktur durch Schußverletzung

: The treatment of a 12-cm bone defect after shotgun fracture of the femur is described. Semitubular corticospongious bone grafts from both iliac crests, 6 cm long and 0.8 cm wide, were tied into two bundles with an absorbable suture and were laid successively into the diaphyseal defect. With another absorbable suture the bundles were anchored to the condylar 95-deg plate. Two months later the condylar plate was removed and an external fixator placed because of inflammation; the bone implants survived. By 18 months after the injury the bone defect was cured, no inflammation was present, and the patient was able to walk with full weight bearing. Four conditions have to be fulfilled in the treatment of an open comminuted fracture with soft tissue defect: thorough necrectomy, rigid fixation, bone grafting and improvement of the blood supply by means of a microvascular musculocutaneous flap.