title: A report of a novel technique: The comprehensive fibular autograft with double metal locking plate fixation (cFALP) for refractory post-operative diaphyseal femur fracture non-union treatment.
abstract: BACKGROUND
  The refractory post-operative diaphyseal femur fracture (DFF) non-union is extremely difficult to treat and remains severe challenges for orthopedists. Although several traditional internal fixations and novel biomedical techniques have been used in managing this complication, its treatment is still fraught with severe challenges.
  
  
  METHODS
  Starting from 1999, 5 patients after three previous internal fixation operations showing refractory DFF non-union underwent the comprehensive fibular autograft with double metal locking plates fixation (cFALP) surgery. The autogenous fibular was first harvested and non-evenly split into two halves in a longitudinal manner. After retracting all previous internal fixation(s), the larger half strut fibula was hammered into the femur canal while the smaller half was fragmented into small pieces and filled surrounding the DFF site. Two locking compression plate were fixed on the lateral and anterior (or antero-lateral) side of the femur, respectively.
  
  
  RESULTS
  The follow-up ranged from 60 to 96 weeks. All cases (100%) achieved bony union without severe complications. The mean time to union was 36±14.7 weeks (range 24-60 weeks).
  
  
  CONCLUSIONS
  The cFALP is a promising surgical modality for DFF non-union treatment. However, because fibular harvest may cause severe complications, the cFLAP should only be considered in refractory DFF non-union cases.
authors.affiliation: Department of Medicine, New Jersey Medical School Affiliated to Rutgers University, Newark, NJ 07103, United States; Department of Neurosurgery, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China. Electronic address: yj244@njms.rutgers.edu.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China. Electronic address: guoyongfei2015@163.com.
authors.forename: Yong-Fei
authors.initials: YF
authors.lastname: Guo
authors.affiliation: Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China. Electronic address: yakemeng2015@163.com.
authors.forename: Ya-Ke
authors.initials: YK
authors.lastname: Meng
authors.affiliation: Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China. Electronic address: leizhu2015@163.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China. Electronic address: chengaiming2015@163.com.
authors.forename: Ai-Ming
authors.initials: AM
authors.lastname: Chen
mesh_terms: D000328:Adult; D001860:Bone Plates; D002681:China; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
keywords: Comprehensive bone graft; Double LCP fixation; Femur; Refractory non-union