{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:42:34Z","timestamp":1787755354706,"version":"build-2784847793"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Case Connector"],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>We report the case of a 41-year-old man who sustained an open femoral shaft fracture with 10 cm of segmental bone loss in a motorcycle collision. He underwent serial irrigation and debridement procedures and intramedullary nailing of the fracture. He was lost to follow-up, but presented 9 months after the injury with abundant callus formation; at 11 months, the simple hypertrophic nonunion was treated with exchange nailing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Although unusual, secondary union of segmental femoral defects may occur. The mechanism by which this occurs is poorly understood, but is likely related to the biology of the fracture site, the effects of reaming, and the mechanics of the fixation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.17.00302","type":"journal-article","created":{"date-parts":[[2018,11,13]],"date-time":"2018-11-13T19:00:49Z","timestamp":1542135649000},"page":"e87-e87","source":"Crossref","is-referenced-by-count":0,"title":["Secondary Union of a Critical Segmental Femoral Defect"],"prefix":"10.2106","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8026-2235","authenticated-orcid":false,"given":"Elizabeth","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3523-466X","authenticated-orcid":false,"given":"Krishna C.","family":"Vemulapalli","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6361-4497","authenticated-orcid":false,"given":"Denise","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3707-0769","authenticated-orcid":false,"given":"James F.","family":"Kellam","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3452-0069","authenticated-orcid":false,"given":"Timothy S.","family":"Achor","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,12]]},"reference":[{"issue":"2","key":"bib1-20230713","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1302\/0301-620X.87B2.15874","article-title":"The management of fractures with bone loss","volume":"87","author":"Keating","year":"2005","journal-title":"J Bone Joint Surg Br."},{"issue":"6","key":"bib2-20230713","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.injury.2011.03.036","article-title":"Masquelet technique for the treatment of bone defects: tips-tricks and future directions","volume":"42","author":"Giannoudis","year":"2011","journal-title":"Injury."},{"issue":"Suppl 2","key":"bib3-20230713","doi-asserted-by":"crossref","first-page":"S72","DOI":"10.1016\/S0020-1383(10)70014-0","article-title":"Reamer-Irrigator-Aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: a review of 25 cases","volume":"41","author":"Stafford","year":"2010","journal-title":"Injury."},{"issue":"1","key":"bib4-20230713","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1302\/0301-620X.75B1.8421008","article-title":"Vascularised fibular grafts for reconstruction of the femur","volume":"75","author":"Yajima","year":"1993","journal-title":"J Bone Joint Surg Br."},{"issue":"3","key":"bib5-20230713","doi-asserted-by":"crossref","first-page":"365","DOI":"10.2106\/00004623-198769030-00007","article-title":"The reconstruction of defects in the femoral shaft with vascularized transfers of fibular bone","volume":"69","author":"Jupiter","year":"1987","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib6-20230713","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1302\/0301-620X.82B7.0821022","article-title":"Vascularised fibular grafts. An experience of 102 patients","volume":"82","author":"Minami","year":"2000","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"bib7-20230713","first-page":"641","article-title":"LEAP Study Group. Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma","volume":"52","author":"MacKenzie","year":"2002","journal-title":"J Trauma."},{"issue":"24","key":"bib8-20230713","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1056\/NEJMoa012604","article-title":"An analysis of outcomes of reconstruction or amputation after leg-threatening injuries","volume":"347","author":"Bosse","year":"2002","journal-title":"N Engl J Med."},{"issue":"10 Suppl","key":"bib9-20230713","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","article-title":"Fracture and dislocation classification compendium \u2013 2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee","volume":"21","author":"Marsh","year":"2007","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib10-20230713","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1097\/BOT.0b013e318224caf0","article-title":"Managing bone defects","volume":"25","author":"Nauth","year":"2011","journal-title":"J Orthop Trauma."},{"issue":"Suppl 5","key":"bib11-20230713","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1097\/BOT.0000000000000978","article-title":"Size matters: defining critical in bone defect size!","volume":"31","author":"Schemitsch","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib12-20230713","first-page":"441","article-title":"Spontaneous healing of large femoral cortical bone defects: does genetic predisposition play a role?","volume":"69","author":"Hinsche","year":"2003","journal-title":"Acta Orthop Belg."},{"issue":"8","key":"bib13-20230713","doi-asserted-by":"crossref","first-page":"e203","DOI":"10.1097\/BOT.0000000000000034","article-title":"Evidence-Based Quality Value and Safety Committee \u2013 Orthopaedic Trauma Association, Writing Committee. Current practice in the management of open fractures among orthopaedic trauma surgeons. Part B: management of segmental long bone defects. A survey of orthopaedic trauma association members","volume":"28","author":"Obremskey","year":"2014","journal-title":"J Orthop Trauma."},{"issue":"10","key":"bib14-20230713","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1097\/BOT.0000000000000887","article-title":"Any cortical bridging predicts healing of supracondylar femur fractures after treatment with locked plating","volume":"31","author":"Strotman","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib15-20230713","doi-asserted-by":"crossref","first-page":"88","DOI":"10.5435\/00124635-200802000-00006","article-title":"Femoral nonunion: risk factors and treatment options","volume":"16","author":"Lynch","year":"2008","journal-title":"J Am Acad Orthop Surg."},{"issue":"1","key":"bib16-20230713","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s13018-014-0088-1","article-title":"Reamed intramedullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion","volume":"9","author":"Hierholzer","year":"2014","journal-title":"J Orthop Surg Res."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01709767-201812000-00012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:41:50Z","timestamp":1787751710000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01709767-201812000-00012"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2018,11,14]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.17.00302","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,14]]}}}