Figure 1

Radiograph of initial managment. A: Initial film post-injury demonstrates the right femoral shaft fracture with a 9cm bony defect. B: The right tibia and fibula also had comminuted, Gustilo type IIIC fractures that necessitated a below-knee amputation. C: A free vascularized tibia-fibular composite graft was used to reconstruct the femoral defect.