Reconstruction of post-traumatic long segment bone defects of the lower end of the femur by free vascularized fibula combined with allograft (modified Capanna's technique).

Abstract

Salvage of long segment bone loss in the limbs particularly near the joints continues to be a challenge to the trauma surgeon. None of the techniques available are universally successful and all share the disadvantages of multi-staged procedures. A reliable single-stage technique would be ideal to reduce the treatment time and the cost of care. We are presenting here our experience of successfully using the modified Capanna technique of combining allograft and free vascularized fibular graft in treating large bone defects in the distal third of the femur. Between April 2012 and October 2013, six patients with post-traumatic long segment bone loss in the distal femur had reconstruction of the bone defect by the Capanna technique. The average age was 33 years (range of 18-49 years). The bone defect ranged from 10 to 20 cm (average 15 cm). Five patients had primary reconstruction while one was done after allograft failure. Bone union time and occurrence of any complications were noted. Follow-up ranged from 7 to 24 months (average 15 months). All grafts went onto union. No patient required secondary procedure to achieve union. Average time to union was 6 months. One patient had deep infection and delayed union of distal end of the fibula graft. Free vascularized fibular graft combined with allograft increases initial stability, allows early weight bearing, has higher chances of union and is a good single-stage technique of reconstruction of distal third femur defects.