Non-vascularised fibular strut graft in segmental bone loss reconstruction following a gunshot injury: Case report

Abstract

Open fractures are complex injuries associated with high morbidity and mortality. Despite advances made in fracture care and infection prevention, these fractures remain a therapeutic challenge. The mechanism and circumstances surrounding these injuries are diverse and include gunshot-related injuries. Ballistic injuries are very severe and commonly reported in the military especially during warfare. But with armed civilian conflicts, these injuries are now commonplace in civilian populations. Gunshots would result in either isolated lesions or a polytrauma patient, with the vital prognosis often at stake. Musculoskeletal lesions characterised by vast soft and bone tissue loss pose a major therapeutic challenge. We present the treatment outcome of a case of Gustilo and Anderson type 3A open type C3 fracture according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO Classification) of the left femoral shaft in its distal third following a gunshot. Bone loss of about 6 cm was managed with an ipsilateral autologous non-vascularised fibular strut graft enhanced with morselised autologous iliac crest bone graft and stabilised with a locking condylar plate. At 4 months after the last surgical procedure, the patient was fully weight-bearing, without pain, and a knee range of movement from 0⁰ extension to 110⁰ of flexion and a draining fistula.