Reconstruction of a segmental bone defect in a long bone can be a challenge. The approach to the bone defect in this case is similar to that used by the musculoskeletal oncologist. This patient choose an allograft option rather than an autograft because of the complications associated with the donor site(s). This option allowed the patient to return to work in the least amount of time. He was aware of the re-fracture and nonunion risk but rationalized that a vascularized autograft could be done if the allograft reconstruction would fail.
The use of a cortical graft in this case created a stable implant-bone-graft construct which allowed early motion. The use of a non-structural autograft would not have been as stable, motion would have been deferred, and external immobilization would have been required. Loss of wrist, elbow, and shoulder motion may have followed.
The patient remains at risk for graft fracture. The plate will not be removed.