Objectives: To study the safety and efficacy of staged reconstruction of distal femoral (supracondylar) bone loss using autologous fibular strut, cortico-cancellous bone grafting.
Design: Single-centre, observational study, with review of literature.
Setting: Urban Level I Trauma Center.
Patients/participants: Eighteen consecutive patients (mean age: 35 ± 8.5 years, all males) with open supracondylar fracture and intercondylar extension (OTA/AO type C3), operated between January 2010 and February 2014 with severe bone loss in 11 patients and moderate loss in 7.
Intervention: Single free fibular strut was used in 12 femurs and dual fibula in 5 femurs with autologous cortico-cancellous bone grafting in all.
Main outcome measures: Clinical union, radiological union, and knee function using the Sanders' score.
Results: Mean follow-up was 45.5 ± 17 months. The mean radiological union time was 18 ± 2.6 weeks. Functional assessment after union revealed one patient with excellent knee function, 9 with good, 8 with fair, function according to Sanders' scoring. The mean knee range was 49 degrees (range 5-110 degrees) in which 9 patients achieved a knee range >80 degrees. Mean limb shortening was 2 cm (range 0-7 cm). No limb shortening was observed in 5 patients. Patients were pain free and had no significant graft or donor site morbidity.
Conclusions: Staged fibular strut grafting, cortico-cancellous bone grafting for traumatic open supracondylar femoral fractures with significant bone loss is a promising technique with a good safety profile and long-term efficacy.
Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.