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Journal of Bone and Joint Surgery, 1947;29:587-597.
© 1947 by The Journal of Bone and Joint Surgery, Inc

RECONSTRUCTION OF DEFECTS OF THE TIBIA AND FEMUR WITH APPOSING MASSIVE GRAFTS FROM THE AFFECTED BONE

JOHN J. FLANAGAN 1 and HENRY S. BUREM 1

1 Orthopaedic Section, Kennedy General hospital, Memphis, Tennessee

This report is based on the end results in the first eight cases, seven tibiac and one femur, treated by this method between December 15, 1943, and September 7, 1945. In all of these cases, bridging of the defects and union of the affected bones were accomplished successfully without the sacrifice of bone length. Since this time, similar procedures have been employed in thirteen additional cases (ten tibiae and three femora). Of the twentyone patients operated upon, there were sixteen successful end results, one refracture twelve months after operation, and four failures due to recurrence of the infection after operation. Two of these failures resulted from infection, secondary to necrosis of scar tissue, adjacent to the operative field. In the other two cases of infection, drainage occurred postoperatively through the operative site. The case with refracture and the four cases of postoperative infection are classified as failures. In the twelfth patient operated upon, the complication of fracture of the sound portion of the proximal fragment of the femur at the site of the crosscut occurred during the operation. This was the result of abnormal leverage in the act of reducing the fragments. It necessitated the application of a lateral bone plate at the site of fracture, and prolonged the operative procedure considerably. Caution is advised, therefore, in the reduction of the fragments and rebedding of the grafts,

[see pdf for figure]

particularly in the femur, where the portion of the extremity distal to the fracture site is heavy and is under the control of an assistant during the manipulation necessary for reduction.


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