Case Report Spontaneous healing of large cortical defects in long bones: Case reports and review of literature Francesco Guerreschi a , Muhammad Inam b, *, Haridimos Tsibidakis a , Alessandro Pelis a a Ilizarov Unit S.C Ortopedia e Traumatologia, Manzoni Hospital, Lecco, Italy b Department of Orthopedic and Trauma, Postgraduate Medical Institute Hayatabad, Medical Complex, Peshawar, Pakistan Summary Bone heals well when the fragments are in full contact and this occurs in ideal situation when there is close fracture. But this is not always the case. High velocity fracture is open most of the time and treatment of such fracture is always challenging [1]. Open fracture needs wound excision and sometime needs trimming of bone end which leads to gap formation in the bone. Such type of gap rarely heals without any intervention [2]. The gap may be filled with cancellous bone, strut graft, cortical graft or with segment transport [3,4]. Segment transport may be bifocal, trifocal or tetrafocal depend on the condition of the bone and size of the gap [5]. For large gap, cortical graft like fibular graft or segment transport are widely used procedures which are technical demanding and time consuming procedures [6]. We present two cases without any head injury in which a large gap in bone was filled and healed without any intervention. Case no 1 A eighteen years old male skeletally matured had motorbike accident in which he sustain multiple injuries. He sustained fracture of the femur, clavicle and ribs. Initially he was treated with internal fixation in other hospital but it became massively infected. He was referred to our unit for Ilizarov fixator. He was very emaciated and was admitted in intensive care unit. He had chest problem and was not able to tolerate anaesthesia for long time or complicated surgery. So, we did minimum, removed the implants and did debridement in first step but infection was not controlled. Then we resected the necrotic end of the bone (which created gap of 11centimeters) and just fixed it with Ilizarov in the hope to control infection. We did not perform osteotomy because of the moribund condition of the patient. As a young patient he was very keen in his health and visit our Ilizarov clinic regularly. When we were waiting for his health to improve and to control infection, we saw new bone formation in the gap. We followed up that patient and about 11 cm of gap was filled and healed without any intervention (Figs. 1–6). Injury, Int. J. Care Injured xxx (2016) xxx–xxx A R T I C L E I N F O Article history: Accepted 21 April 2016 Fig. 1. Infected broken implant. * Corresponding author. Tel.: +92 319922671. E-mail addresses: f.guerreschi@ospedale.lecco.it (F. Guerreschi), dr_mohammadinam@yahoo.co.uk (M. Inam), tsibidakis@hotmail.com (H. Tsibidakis), a.pelis@ospedale.lecco.it (A. Pelis). G Model JINJ-6704; No. of Pages 5 Please cite this article in press as: Guerreschi F, et al. Spontaneous healing of large cortical defects in long bones:Case reports and review of literature. Injury (2016), http://dx.doi.org/10.1016/j.injury.2016.04.033 Contents lists available at ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y http://dx.doi.org/10.1016/j.injury.2016.04.033 0020–1383/ß 2016 Elsevier Ltd. All rights reserved.