Surgical Discussion

Patient positioning:  Supine positioning on a radiolucent table to facilitate intraoperative imaging and access to the femoral diaphysis.

Anatomical surgical approach:  A lateral approach to the femur was utilized, involving an incision over the lateral aspect of the thigh. Dissection proceeded through the fascia lata to expose the femoral shaft. Care was taken to preserve soft tissue integrity around the fracture site.

The initial bone grafting significantly reduced the segmental defect from 12cm to a smaller size. The Masquelet technique was not considered a failure as it often requires multiple grafting procedures for large defects. The surgical team emphasized the importance of patient understanding regarding the potential need for additional operations. Alternative strategies such as corticotomy and transport using external frames or nail transport were considered but required high patient compliance.

Postoperative protocol:   Postoperative rehabilitation included limited weight-bearing with gradual progression as tolerated. Regular follow-up was essential to monitor bone healing and integration of the graft.

Follow up:   Not specified.

Orthopaedic implants used:   External fixator, intramedullary nail, cement spacer, autologous bone graft.