Introduction

Conservative treatment of Achilles tendon ruptures may lead to re-rupture. Open surgical repair entails a risk of skin necrosis or infection. Several percutaneous techniques have been used, like Tenolig® or Achillon®, but these techniques are costly and may be marred by wound healing problems. Ma and Griffith described a technique for percutaneous repair witch left the suture and the knot under the skin, thus reducing the risk for infection.

Purpose: Treatment of major bone loss still raises difficult reconstruction problems. For bone tumours, massive resection prostheses allow rapid reconstruction of the architecture and satisfactory function. Several publications have reported the use of autoclave-sterilised cortical autografts for the treatment of bone tumours but only two old publications (1961) have used this method for the treatment of major bone loss in limb traumatology.

Case report: A 17-year-old male patient was transported from a neighbouring island after a motorcycle accident. The patient presented Cauchoix stage 2 fracture of the lower end of the femur with bone lose measuring 11 cm. The complete diaphysometaphyseal segment was recovered on the road and was brought in a sack. Emergency debridement was performed followed by complete skin closure and transcalcaneal traction. The femoral cortical fragment was cleaned and sterilised in the autoclave with one cycle at 121°C for 20 minutes at 1.3 bars. Twenty days later, osteosynthesis was performed using a large 95° Muller plate via a lateral approach. The cortical segment was put in position enabling complete recovery of length, alignment and rotation. Rehabilitation was initiated postoperatively. Total weight bearing began at three months and nautical sports (wind surf, surfing) at six months. Complete recovery of motion was achieved (heal-buttocks). Extension was normal and symmetrical both actively and passively with no recurvatum.

Results: Successive postoperative x-rays taken at 1.5 and 4 months and 1, 2, 3, 4, 6, and 7 years showed excellent graft incorporation. Healing of the metaphyseal and diaphyseal interfaces was complete at two years. Biopsy of the metaphyseal zone showed a normal bone structure.

Discussion: This exceptional case illustrates the capacity of this method to allow total recovery of function, an outcome rarely achieved after such important bone loss.