Osteoperiosteal Decortication and Autogenous Cancellous Bone Graft Combined with Bridge Plating for Non-hypertrophic Diaphyseal Nonunion.

BACKGROUD: The aim of this study was to evaluate results of osteoperiosteal decortication and autogenous cancellous bone graft combined with a bridge plating technique in atrophic and oligotrophic femoral and tibial diaphyseal nonunion. METHODS: We retrospectively reviewed 31 patients with atrophic or oligotrophic femoral and tibial diaphyseal nonunion treated with osteoperiosteal decortication and autogenous cancellous bone graft between January 2008 and December 2018. Patients with hypertrophic nonunion, infected nonunion, and nonunion treated with autogenous cancellous bone graft alone were excluded. The nonunion site was exposed by using the Judet technique of osteoperiosteal decortication. Nonunion with a lack of stability was stabilized with a new plate using a bridge plating technique or augmented by supplemental fixation with a plate. Nonunion with malalignment was stabilized with a new plate after deformity correction. Autogenous cancellous bone graft was harvested from the posterior iliac crest and placed within the area of decortication. A basic demographic survey was conducted, and the type of existing implants, mechanical stability of the implants, the type of implants used for stabilization, the operation time, the time to bone union, and postoperative complications were investigated. RESULTS: The average follow-up period was 33.3 months (range, 8-108 months). The operation time was 207 minutes (range, 100-351 minutes). All but 1 nonunion (96.7%) were healed at an average of 4.2 months (range, 3-8 months). In 1 patient, bone union failed due to implant loosening with absorbed bone graft, and solid union was achieved by an additional surgery for stable fixation with a new plate, osteoperiosteal decortication, and autogenous cancellous bone graft. There were no other major complications such as neurovascular injuries, infection, loss of fixation, and malunion. CONCLUSIONS: Osteoperiosteal decortication and autogenous cancellous bone graft combined with stable fixation by bridge plating showed reliable outcomes in atrophic and oligotrophic diaphyseal nonunion. This treatment modality can be effective for treating atrophic and oligotrophic diaphyseal nonunion because it is very helpful stimulating bone union.

Comparison of autogenous cancellous bone grafting and extracorporeal shock wave therapy on osteotomy healing in the tibial tuberosity advancement procedure in dogs. Radiographic densitometric evaluation.

OBJECTIVES: To compare optical values in the osteotomy gap created after a tibial tuberosity advancement (TTA) treated with autogenous cancellous bone graft, extracorporeal shock wave therapy, a combination of autogenous cancellous bone graft and extracorporeal shock wave therapy, and absence of both autogenous cancellous bone graft and extracorporeal shock wave therapy using densitometry. METHODS: Dogs that were presented for surgical repair of a cranial cruciate ligament rupture were randomly assigned to one of four groups: TTA with autogenous cancellous bone graft (TTA-G), TTA with autogenous cancellous bone graft and extracorporeal shock wave therapy (TTA-GS), TTA with extracorporeal shock wave therapy (TTA-S), and TTA with no additional therapy (TTA-O). Mediolateral radiographs at zero, four and eight weeks after surgery were evaluated to compare healing of the osteotomy gap via densitometry. An analysis of variance was used to compare the densitometric values between groups. RESULTS: At four weeks after surgery, a significant difference in osteotomy gap density was noted between TTA-GS (8.4 millimetres of aluminium equivalent [mmAleq]) and TTA-S (6.1 mmAleq), and between TTA-GS (8.4 mmAleq) and TTA-O (6.4 mmAleq). There were no significant differences noted between any groups at the eight week re-evaluation. CLINICAL SIGNIFICANCE: There were no significant differences in the osteotomy gap density at eight weeks after surgery regardless of the treatment modality used. The combination of autogenous cancellous bone graft and extracorporeal shock wave therapy may lead to increased radiographic density of the osteotomy gap in the first four weeks after surgery. Densitometry using an aluminium step wedge is a feasible method for comparison of bone density after TTA in dogs.

Autogenous Cancellous Bone Graft Harvested from Proximal Tibia in Foot and Ankle Surgery / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate clinical availability and advantage of autogenous cancellous bone graft from proximal tibia metaphysis. MATERIALS AND METHODS: A retrospective review was conducted of 58 cases of foot and ankle surgeries using bone graft from the ipsilateral proximal tibia from August 2008 to March 2012 in Konkuk University Medical Center (Seoul, Korea). The group included patients with isolated reconstructions as well as trauma in the foot and ankle area. RESULTS: The mean volume of cancellous bone harvested from the proximal tibia was 14 ml (range, 5 to 28 ml) and allograft was added to the autogenous bone graft in order to fill the large bone defect for six cases. The bone graft was performed for 41 arthrodesises, seven supramalleolar tibial osteotomies, eight open reduction and internal fixation procedures, and two curettage and bone grafts of bone tumor. At final follow-up, one case (1.7%) showed mild pain on the donor site and the mean visual analogue scale score for pain was 0.1 (range, 0 to 2). There was no occurrence of major post-operative complication at the donor site. Solid union at final follow-up was observed in 97% of cases. CONCLUSION: Proximal tibial bone graft was found to be a viable alternative to the iliac crest bone graft in the aspect of cancellous bone graft with relatively sufficient quantity and minimal donor site morbidity.

The Treatment of Non-union of Humeral Shaft / 대한정형외과학회잡지

The non-surgical treatment for the fresh humeral shaft fracture would appeared to be not sufficient in respect of immobilization and maintenance of the contact surface of the fracture ends, which have had stimulated surgeons to perform internal fixation. This might be one of the reasons to produce non-union of humeral shaft fracture, supplemented by increasing incidence of fractures due to car and machinary accident. Authors have experienced 18 cases of non-union of humeral shaft fracture and accomplished solid union in all cases by osteosynthesis accompanied by autogenous bone graft. In detail: 1. Non-union was prevalent in the agr group of 20 to 40 and mostly in male. Site of non-union was found mostly at the lower 2/3. 2. The cause of the fracture was mainly due to the car and machinary accident. Initial treatments were surgical in 14 out of 18 cases, and 12 cases of this surgically treated group were treated within 2 days after the injury. 3. On retrospective analysis of medical records and X-ray films, probable cause of the non-union were supposed to be too early performed inadequate internal fixation and post-operative infection in the operated cases, whereas distraction of fracture ends due to poor external fixation and infection in the cases treated conservatively. 4. 16 cases of established non-union were treated by authors with rigid internal fixation and additional bone graft, and 1 case with bone graft only. 5. Authors have utilized shoulder spica or long arm cast post-operatively for 1 to 4 months. 6. Union was obtained in all cases. Developed transient radial nerve palsy in 4 cases; and neighbouring joints contracture in 2 cases, which required considerable time of physical therapy.