Mechanobiology in the management of mobile atrophic and oligotrophic tibial nonunions

Ferreira, Nando; Marais, Leonard Charles; Aldous, Colleen

doi:10.1016/j.jor.2015.10.012

Cited by 14 publications

(3 citation statements)

References 35 publications

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“…IM tibial and femoral nails allow for mild compression to be delivered at the time of surgery [15, 16] but provide no mechanism to sustain the compression over time. Circular external fixation provides an alternative method for nonunion management with the advantage of providing sustained compression during the recovery period but requires wearing the frame for a prolonged post-operative course [17–19]. Surgeons have gone to great lengths to achieve compression, even integrating IM nails with circular fixators as in the compression over a nail technique [20].…”

Section: Introductionmentioning

confidence: 99%

The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report

Fragomen

Wellman

Rozbruch

2019

Arch Orthop Trauma Surg

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IntroductionThe magnetic intramedullary (IM) compression nail is capable of providing sustained compression for the treatment of nonunions of long bones. This ability was previously only possible with the use of external fixation. We asked the following questions: How effective is the IM compression nail at achieving union? How do we know when adequate compression has been attained? Which types of nonunions are good candidates for this treatment?Materials and methodsFourteen patients with nonunions of the tibia (5) or femur (9) were treated with the PRECICE IM compression nail. The average age was 49 years number of previous surgeries was 1.9, 7 were atrophic and 7 normotrophic, 3 were metaphyseal and 11 diaphyseal. All PRECICE IM nails were pre-distracted prior to implantation. Compression was applied post-operatively until the locking bolts were seen on X-ray to be bending or the nail was no longer shortening despite applying the external magnet.ResultsUnion was achieved in 13/14 cases. The time to union was 24.5 weeks (range 11–60). The two proximal tibia metaphyseal nonunions, both deformed into varus (4°) and flexion (10°) after compression was applied with one failing to unite. The distal tibia metaphyseal and diaphyseal nonunions did not deform upon compression. Three patients had positive cultures and were treated with IV antibiotics for 6 weeks followed by 3 months of oral suppression without subsequent infection. No mechanical nail failures were seen.ConclusionsThe IM compression nail was successful at applying compression, preventing deformity, and obtaining union in all diaphyseal and in distal tibia metaphyseal nonunions. Signs of active compression are bending of the locking bolts and failure of the nail to shorten. Proximal tibia metaphyseal nonunion may not be suited for this treatment.

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Section: Introductionmentioning

confidence: 99%

The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report

Fragomen

Wellman

Rozbruch

2019

Arch Orthop Trauma Surg

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“…By adding controlled compression at the non-union site, the stability is further increased and as such, union was achieved in both hypertrophic and atrophic/oligotrophic non-unions alike by addressing the stability at the non-union site. 19,22,23…”

Section: Discussionmentioning

confidence: 99%

Intramedullary nailing of tibial non-unions using the suprapatellar approach: a case series

Botma¹,

Graham²,

Held³

et al. 2020

SA orthop. j

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Background: A number of treatment options are available for diaphyseal non-unions of the tibia, including intramedullary (IM) nailing. An infrapatellar entry point with the knee in deep flexion can make this procedure challenging, especially with associated deformity or an obliterated canal. The suprapatellar approach allows nail insertion with the knee extended, which facilitates correction of malalignment in the sagittal and coronal planes. The aim of our study was to review the outcome of diaphyseal tibial non-unions, treated with an intramedullary nail, using the suprapatellar approach. Method: We retrospectively reviewed consecutive cases with non-union of the tibial shaft, treated with a suprapatellar entry nail between May 2016 and January 2018. Patients who were previously managed with a nail or who had active sepsis were excluded. The rate and time to union, as well as complications were assessed. Results: Thirteen cases were included and followed up until union at a mean of 5.8 months. All were performed percutaneously, without opening of the non-union site. Two patients developed complications, although bony union was still achieved. Conclusion: A suprapatellar entry tibial nail is an acceptable treatment option for tibial non-unions not previously treated with a nail.

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“…A gyógyító eljárások döntő többségében a reoperációk valamilyen formában kombinálódnak autológ spongiosa átültetéssel. Ezekben az esetekben kiemelkedő csontátépülési eredményeket publikáltak (sikerráta: 75%-100%) (1,2,4). A csípőlapátból hagyományosan nyert autológ spongiosának számos szövődménye lehet, mint az emelkedett posztoperatív vérvesztés, donor területi fájdalom, posztoperatív infekció.…”

Section: Megbeszélésunclassified

Minimál invanzív technikával nyert spongiosa autograft használata álízület kezelésében : Esetbemutatás

Pap¹,

Domaraczki²,

Tácsik³

et al. 2018

MTO

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KAZUISZTIKA ÖSSZEFOGLALÁS Az álízület kezelése mindig nagy kihívás egy mozgásszervi sebésznek. A megfelelő stabilizáló eljárás után oligo-, illetve atrophiás álízületnél valamilyen csontátültetésre van szükség. Ezt az esetek többségében a csípőlapátból kell eltávolítani, ahol magas a donor területi morbiditás. Ennek elkerülésére alkalmaztunk egy általunk kifejlesztett minimál invazív eljárást. Cikkünkben egy 41 éves nőbeteg esetén keresztül mutatjuk be, akinek a fibula álízületét kezeltük a tibia proximalis részből vett csont allografttal a mozaikplasztikához készült műszerkészlet segítségével. Kulcsszavak:Álízület; Csontátültetés; Minimál invazív technika; L. Hangody: Usage of cancellous bone autograft harvested with minimally invasive technique for non-union treatment. Case reportA variety of treatment options are available for patients with oligo-and atrophic non-unions without bone defects, but the optimal surgical approach remains a challenge for orthopedic surgeons. Several treatments are used in clinical practice; however most of the surgical procedures need to be combined with autologous bone grafting. The bone graft regularly comes from the iliac crest. This treatment often suffers donor site morbidity. In the next case report we present our new minimally invasive technique for bone autograft harvesting

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Mechanobiology in the management of mobile atrophic and oligotrophic tibial nonunions

Abstract: Mechanobiological stimulation of tibial nonunions can produce union even if the biological activity appears to be low.

Cited by 14 publications

References 35 publications

The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report

The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report

Intramedullary nailing of tibial non-unions using the suprapatellar approach: a case series

Minimál invanzív technikával nyert spongiosa autograft használata álízület kezelésében : Esetbemutatás

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