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RECONSTRUCTION OF DEFECTS OF THE TIBIA AND FEMUR WITH APPOSING MASSIVE GRAFTS FROM THE AFFECTED BONE
JOHN J. FLANAGAN; HENRY S. BUREM
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Orthopaedic Section, Kennedy General hospital, Memphis, Tennessee
1947 by Boston, American Orthopaedic Association
The Journal of Bone & Joint Surgery.  1947; 29:587-597 
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Abstract

This report is based on the end results in the first eight cases, seven tibiac and one femur, treated by this method between December 15, 1943, and September 7, 1945. In all of these cases, bridging of the defects and union of the affected bones were accomplished successfully without the sacrifice of bone length. Since this time, similar procedures have been employed in thirteen additional cases (ten tibiae and three femora). Of the twentyone patients operated upon, there were sixteen successful end results, one refracture twelve months after operation, and four failures due to recurrence of the infection after operation. Two of these failures resulted from infection, secondary to necrosis of scar tissue, adjacent to the operative field. In the other two cases of infection, drainage occurred postoperatively through the operative site. The case with refracture and the four cases of postoperative infection are classified as failures. In the twelfth patient operated upon, the complication of fracture of the sound portion of the proximal fragment of the femur at the site of the crosscut occurred during the operation. This was the result of abnormal leverage in the act of reducing the fragments. It necessitated the application of a lateral bone plate at the site of fracture, and prolonged the operative procedure considerably. Caution is advised, therefore, in the reduction of the fragments and rebedding of the grafts,

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particularly in the femur, where the portion of the extremity distal to the fracture site is heavy and is under the control of an assistant during the manipulation necessary for reduction.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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