RECONSTRUCTION OF AN 11-CM FEMORAL DEFECT NONUNION USING STRUCTURAL FIBULAR AUTOGRAFT AND LOCKING PLATE FIXATION: A CASE REPORT

Introduction and importance: Femoral diaphyseal nonunion with a large segmental defect is a demanding reconstructive problem, particularly after multiple operations and previous infection. Restoring both biology and mechanical stability is essential when infection has become quiescent.
Case presentation: A 33-year-old woman presented with severe functional impairment of the left lower limb after a road traffic accident in 2007 and multiple subsequent procedures, including intramedullary nailing, plate fixation, external fixation, implant removal, and treatment of recurrent infection. At presentation, there were multiple scars, an antalgic gait requiring crutches, pelvic tilt, and an 8-cm limb-length discrepancy. Laboratory inflammatory markers were within normal limits, and imaging demonstrated an atrophic femoral nonunion with an 11-cm interfragmentary defect. After debridement and restoration of the medullary canal, a 15-cm structural fibular autograft harvested from the ipsilateral leg was inserted across the defect. Additional allograft from two femoral heads was placed around the reconstruction, which was stabilized with a 14-hole locking plate.
Clinical discussion: Large femoral defect nonunion requires simultaneous control of infection risk, restoration of the biological environment, and durable fixation. A structural fibular autograft provides cortical support across the defect, while supplementary allograft increases graft volume and locking plate fixation provides mechanical stability. In this patient, serial clinical and radiographic follow-up showed progressive bone healing without clinical evidence of recurrent infection and with improved functional mobility.
Conclusion: Structural fibular autografting combined with allograft augmentation and locking plate fixation can be considered a reconstructive option for selected large femoral defect nonunions after infection has been excluded or controlled.