{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:16:21Z","timestamp":1783350981660,"version":"3.54.6"},"reference-count":22,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Massive post-traumatic segmental bone defects exceeding 5 cm\u2014particularly those resulting from Gustilo\u2013Anderson type IIIB open fractures\u2014present a formidable reconstructive challenge. Autologous bone graft, though biologically superior, is restricted in this context by limited harvest volume and donor-site morbidity. Nonvascularized structural bone allografts provide unrestricted graft volume and immediate mechanical support, but data on their performance in severely compromised post-traumatic environments remain sparse. Methods: This retrospective case series evaluated three patients with massive distal femoral bone loss following high-energy trauma. All were managed with a staged protocol: radical debridement and temporary joint-spanning external fixation at index surgery, followed by definitive reconstruction with a matched nonvascularized structural allograft and retrograde intramedullary nailing once the host bed was aseptic and soft-tissue coverage was established. Results: Limb salvage was achieved in all three patients at a mean follow-up of 18 months. Two patients attained stable biological integration and restored anatomical alignment; one of these progressed to full unassisted weight-bearing by four months postoperatively. The third patient developed symptomatic pseudarthrosis at the distal host\u2013graft junction. The proximally integrated allograft had preserved sufficient femoral bone stock to serve as anchorage for a segmental total knee arthroplasty performed two years after the index reconstruction, ultimately preventing amputation. Conclusions: Nonvascularized structural allografts combined with rigid intramedullary nailing constitute a reproducible limb salvage strategy for massive femoral defects. The allograft functions not only as a vehicle for primary biological union, but as a structural reserve\u2014maintaining femoral axis and bone stock that remains available for secondary arthroplasty reconstruction should union fail.<\/jats:p>","DOI":"10.3390\/jcm15135266","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:43:14Z","timestamp":1783345394000},"page":"5266","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of Nonvascularized Structural Bone Allografts for Reconstruction of Massive Post-Traumatic Segmental Femoral Bone Defects: A Retrospective Case Series"],"prefix":"10.3390","volume":"15","author":[{"given":"Arpad","family":"Solyom","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Sciences and Technology, Street Gheorghe Marinescu 38, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Mathe","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Sciences and Technology, Street Gheorghe Marinescu 38, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2227-5333","authenticated-orcid":false,"given":"Fodor","family":"Pal","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Sciences and Technology, Street Gheorghe Marinescu 38, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","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 Jt. Surgery. Br."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103606","DOI":"10.1016\/j.otsr.2023.103606","article-title":"Combined structural allograft and tantalum cone to manage segmental metaphyseal tibial bone defect in revision knee arthroplasty","volume":"109","author":"Bougaud","year":"2023","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1089\/ten.teb.2020.0281","article-title":"Regenerative Approaches for the Treatment of Large Bone Defects","volume":"27","author":"Stahl","year":"2021","journal-title":"Tissue Eng. Part B Rev."},{"key":"ref_4","first-page":"224","article-title":"Bone grafts and biomaterials substitutes for bone defect repair: A review","volume":"2","author":"Wang","year":"2017","journal-title":"Bioact. Mater."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"65","DOI":"10.13107\/jocr.2022.v12.i02.2670","article-title":"Management of Short Proximal Femur Nail Peri Peri-Implant Fracture of Femur Shaft with Implant Removal and Long Distal Femur Locking Plate and Bone Grafting\u2014A Case Report","volume":"12","author":"Mahajan","year":"2022","journal-title":"J. Orthop. Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2111","DOI":"10.1111\/os.14193","article-title":"The Ilizarov Technique: A Dynamic Solution for Orthopaedic Challenges","volume":"16","author":"Guan","year":"2024","journal-title":"Orthop. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1007\/s00402-020-03562-9","article-title":"Functional outcome and complications after treatment of comminuted tibial fractures or deformities using Ilizarov bone transport: A single-center study at 15- to 30-year follow-up","volume":"141","author":"Biz","year":"2021","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"100858","DOI":"10.1016\/j.mtbio.2023.100858","article-title":"Recent advancement in vascularized tissue-engineered bone based on materials design and modification","volume":"23","author":"Liu","year":"2023","journal-title":"Mater. Today Bio"},{"key":"ref_9","first-page":"738","article-title":"Modified Masquelet technique for reconstruction of critical bone defects","volume":"127","author":"Fischer","year":"2024","journal-title":"Unfallchirurgie"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e328","DOI":"10.1097\/BOT.0000000000002065","article-title":"Reconstruction of Septic Tibial Bone Defects With the Masquelet Technique and External Ring Fixation-A Low Healing Rate and High Complication and Revision Rates","volume":"35","author":"Lotzien","year":"2021","journal-title":"J. Orthop. Trauma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"10225536221102685","DOI":"10.1177\/10225536221102685","article-title":"A meta-analysis of the Masquelet technique and the Ilizarov bone transport method for the treatment of infected bone defects in the lower extremities","volume":"30","author":"Ren","year":"2022","journal-title":"J. Orthop. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e40960","DOI":"10.1097\/MD.0000000000040960","article-title":"Giant cell tumor of proximal femur managed by extended curettage with fibular strut allograft using long intramedullary interlocking nail: A case report and literature review","volume":"103","author":"Song","year":"2024","journal-title":"Medicine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3047","DOI":"10.1111\/os.13498","article-title":"Triangular Mechanical Structure of the Proximal Femur","volume":"14","author":"Xu","year":"2022","journal-title":"Orthop. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"97","DOI":"10.5435\/00124635-200702000-00004","article-title":"Intramedullary nailing of the lower extremity: Biomechanics and biology","volume":"15","author":"Bong","year":"2007","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"971","DOI":"10.2106\/00004623-200107000-00001","article-title":"Retrieved human allografts: A clinicopathological study","volume":"83","author":"Enneking","year":"2001","journal-title":"J. Bone Jt. Surgery. Am."},{"key":"ref_16","first-page":"27","article-title":"The concept of induced membrane for reconstruction of long bone defects","volume":"41","author":"Masquelet","year":"2010","journal-title":"Orthop. Clin."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"142","DOI":"10.5435\/JAAOS-20-03-142","article-title":"Induced membrane technique for reconstruction to manage bone loss","volume":"20","author":"Taylor","year":"2012","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/01.blo.0000150371.77314.52","article-title":"Infection in massive bone allografts","volume":"432","author":"Mankin","year":"2005","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s00264-008-0700-2","article-title":"Survival of massive allografts in segmental oncological bone defect reconstructions","volume":"33","author":"Bullens","year":"2009","journal-title":"Int. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1002\/micr.20841","article-title":"Vascularized fibula transfer for lower limb reconstruction","volume":"31","author":"Beris","year":"2011","journal-title":"Microsurgery"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1007\/s00264-007-0362-5","article-title":"Initial stability of circumferential meshes with impacted bone allografts for massive femoral defects","volume":"32","author":"Guala","year":"2008","journal-title":"Int. Orthop."},{"key":"ref_22","first-page":"e73210","article-title":"Locally Delivered Antibiotics in Fracture-Related Infection","volume":"16","author":"Mills","year":"2024","journal-title":"Cureus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5266\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:41:32Z","timestamp":1783348892000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":22,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135266"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135266","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]}}}