Work

Reconstruction of Large Femoral Segmental Defects in Conflict-Related Trauma Using Non-vascularized Fibular and Iliac Crest Grafts: A Case Series

Year: 2026

Type: article

Abstract: Introduction/objectives Large post-traumatic femoral segmental defects with established nonunion represent a challenging reconstructive problem, particularly in conflict-affected and resource-limited environments where access to microsurgical reconstruction and prolonged staged procedures may be limited. Non-vascularized fibular grafting (NVFG) combined with autologous iliac crest bone grafting (ICBG) may provide both structural and biological support for reconstruction. This case series describes the clinical experience with this combined approach in patients with large femoral segmental defects following conflict-related trauma. Methods A case series of eight patients with femoral nonunion and segmental bone loss was conducted at the Jordanian Field Hospital in southern Gaza (Khan Younis) between June and September 2024. Patients were identified at presentation with established nonunion and segmental bone defects and underwent reconstruction using combined NVFG and autologous ICBG. Definitive reconstruction was performed as a single procedure in most patients, whereas staged management was undertaken when required for infection control. Clinical and radiographic follow-up were retrospectively reviewed, with outcomes assessed from routine postoperative clinical and radiographic follow-up for 13-18 months. The primary clinical outcome was radiographic progression to union, with additional assessment of complications, limb function, and need for revision surgery. Results The eight patients included six males and two females, with a mean age of 27.9 years (range, 12-40 years). Seven injuries resulted from blast trauma and one from a gunshot injury. Four patients had Gustilo type IIIC injuries, three had type IIIA injuries, and one had a closed injury. Segmental bone defects ranged from 6 to 24 cm, with five patients having defects exceeding 10 cm. Six patients achieved primary union, one achieved functional union with a residual cortical gap, and one achieved union after revision fixation following implant failure associated with premature weight bearing. Mean time to radiographic union was 7.3 months (range, 6-9 months). Four patients (50%) experienced complications, including implant failure requiring revision, residual limb-length discrepancy, and residual cortical deficiency. Conclusion Reconstruction using NVFG combined with autologous ICBG may represent a feasible option for large post-traumatic femoral segmental defects in conflict-affected and resource-limited settings. The technique provides structural support and biological augmentation without the microsurgical complexity of vascularized bone grafting. In this small case series, it offered a practical limb-salvage strategy in a high-demand environment, with staged infection management used when clinically required.

Source: Cureus

DOI: 10.7759/cureus.117328