The reconstruction of defects in the femoral shaft with vascularized transfers of fibular bone.

Seven major reconstructions of the femoral shaft using a vascularized graft of bone from the fibula were performed at the Massachusetts General Hospital from 1981 to 1984. Three patients had a post-traumatic infected non-union; one, extensive osteomyelitis of the femoral shaft; one, a fractured allograft; one, an atrophic non-union associated with radiation therapy; and one, post-traumatic loss of a ten-centimeter segment of bone. Six of the seven patients had a skeletal femoral defect, ranging from seven to fifteen centimeters in length. The average length of fibula that was used for reconstruction was 19.6 centimeters. Primary skeletal union occurred in five of the seven patients. Two patients had healing only at the distal junction and required a conventional bone graft and supplementary internal fixation of the proximal junction. At an average length of follow-up of thirty-four months, all of the patients were able to walk. Only two patients, both of whom had an extreme limb-length discrepancy, required additional support.