Plate augmentation and autologous bone grafting after intramedullary nailing for challenging femoral bone defects: a technical note

The treatment of a large segmental defect of over 6 cm in a long bone is a challenging procedure. Treatment options include cancellous bone graft (e.g., the Masquelet technique), vascularized fibular graft (VFG), and internal bone transport (IBT) with an external fixator. These methods may be performed with intramedullary (IM) nailing or plate fixation to enhance stability or to lessen the time of external fixation. Each method has its own advantages and limitations. This study aimed to describe the advantages of additional plate augmentation and autologous bone grafting after IM nail implantation. Three patients with large segmental femoral bone defects were treated with IM nail implantation; then, one- or two-stage autologous iliac bone grafting with additional plate augmentation was performed. All patients achieved bony union without metal failure. We describe a technique involving additional plate augmentation and autologous iliac bone grafting for treating large femoral defects after restoring the length of the femur using an IM nail implantation and an external fixator.