Femoral Bone Defect

A 28 year old man who had a motorcycle accident the previous year presented with pain in his left lower extremity while weight-bearing. After the accident, internal fixation was used to stabilize his open femoral fracture and closed tibial fracture. He developed a post-operative infected femoral nonunion, which was treated successfully with antibiotics. At presentation in our clinic, he had a segmental bone defect, possible chronic osteomyelitis, knee contracture secondary to rectus femoris contracture, a significantly atrophied gluteus maximus, and 10° of ankle equinus. Labwork at time of presentation showed that his inflammatory markers were within normal limits, and he did not have any clinical evidence of infection. The patient underwent rod exchange with an antibiotic cement-coated rod, insertion of bone graft mixed with vancomycin and BMP-2, and manipulation of the knee while under anesthesia. At 8-month follow-up, the nonunion site had consolidated and the wounds had healed with no evidence of drainage. His knee flexion improved from 90° to 130°. He was able to dorsiflex his foot to neutral with the knee in extension and to just past neutral with the knee flexed. He also reported that he was able to run and had returned to work.