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Free vascularized fibular grafts have been widely used for the reconstruction of long bone defects. However, the use of a vascularized tibial graft is precluded by its weight-bearing function and unacceptable donor site morbidity.    Case presentation  We present a rare case of using a vascularized tibia-fibular composite graft taken from a 6-year-old Chinese boy’s ipsilateral lower leg to reconstruct a large bony defect of his traumatic femur. Hypertrophy of the tibial graft, good remodeling of the femoral shaft, and atrophy of the unloaded fibular graft were noted at the 10-year follow up. He was able to participate in outdoor activities such as basketball while wearing his prosthesis.    Conclusions  The 10-year follow up demonstrates the feasibility of this salvage procedure for a floating knee injury with neurovascular compromise.

A free vascularized tibia-fibular composite graft for the traumatic femoral bony defect of a 6-year-old boy with 10-year follow up: a case report