title: Tubular Remodeling of Massive Cancellous Bone Graft in the Treatment of Long Bone Defects.
abstract: BACKGROUND
  This case report describes the clinical and radiological result at the 4.5-year follow-up after an extensive reconstruction of the femoral diaphysis using autologous cancellous bone graft. The radiological study including axial tomography demonstrates secondary remodelling to form tubular diaphyseal bone.
  
  
  METHODS
  A patient with an existing hip fusion, who sustained a fracture of the proximal femur 12 years later, was treated by open internal fixation using a plate and screws. Infection followed which became chronic, causing bone resorption and necrosis and producing a septic non-union. Reconstruction in two stages was performed: open radical debridement which ended with a 14.5 cm diaphyseal defect of the femur, temporary alloplastic spacer interposition and secondary de-arthrodesis of the hip with massive autologous cancellous grafts into the induced foreign body membrane left by the spacer. Fixation was provided by a plate and screws.
  
  
  RESULTS
  The femur was free of infectious recurrence at 4.5 years. The patient walks without crutches with a shortened lower limb using a leg length compensation shoe and a painfree sine-sine hip arthroplasty. The former bone defect is fully remodelled into new cortical bone. X-ray and CT-scan demonstrate the tubular form of the reconstructed bone.
  
  
  CONCLUSIONS
  This clinical case demonstrates the restoration of a medullar cavity after massive cancellous bone grafting of a diaphyseal defect of the femur. The question remains open as to whether the foreign body membrane has only a simple passive protective function against extraosseous bone resorbing factors or whether it functions actively by producing growth factors or other beneficial bone inducing factors.
authors.affiliation: Reparto di Chirurgia, Ospedale la Carità, Locarno, Switzerland. almuaid@bluewin.ch.|Reparto di Chirurgia, Ospedale la Carità, Via Ospedale 1, Locarno, 6600, Switzerland. almuaid@bluewin.ch.
authors.forename: Jaleel
authors.initials: J
authors.lastname: Al-Muaid
authors.affiliation: Reparto di Medicina Interna, Ospedale Regionale di Bellinzona e Valli, sede San Giovanni, Bellinzona, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Franciolli
authors.affiliation: Reparto di Chirurgia Ortopedica, Clinica Lugnaese, sede Moncucco, Lugano, Switzerland.
authors.forename: Kaj
authors.initials: K
authors.lastname: Klaue
keywords: Bone graft; Long bone defect; Tubular remodeling