Tricortical Bone Grafts for Treatment of Malaligned Tibias and Fibulas

Abstract

Malunions and malaligned nonunions of the tibia and fibula after fracture alter limb function and can be corrected only with surgical intervention. We sought to determine whether using tricortical portions of the iliac crest in conjunction with osteotomy and internal fixation could successfully treat malunions and malaligned nonunions of the tibia and fibula. Seventeen patients with either a malunion or a malaligned nonunion of the tibia or fibula were treated with an osteotomy, deformity correction, and placement of an autogenous iliac crest tricortical bone graft with open reduction and internal fixation (ORIF). The minimum followup was 3 months (average, 32 months; range, 3-118 months). Sixteen patients (94%) had clinical and radiographic evidence of healing at an average of 99 days (range, 43-229 days). Major complications occurred in four patients; one had a persistent nonunion, two had wound infections, and one underwent resection of the distal fibula for subsequent development of fibulotalar arthrosis after ankle arthrodesis. Minor complications occurred in two patients, one tendinitis and one persistent malunion. There were no complications at the iliac crest bone graft site. Autogenous iliac crest tricortical bone grafts, when used in conjunction with correction of alignment and stable internal fixation, are a reasonable option for treatment of nonunions and malaligned nonunions of the tibia and fibula.

Radioprotection and cross‐linking of allograft bone in the presence of vitamin E

“…It is possible that vitamin E can also protect the destruction of proteins other than collagen in the allograft network and may contribute to an enhanced interaction with the host bone. Finally, our in vivo model is nonloading, whereas in clinical practice allografts are often used in weight‐bearing settings (Borrelli et al, ; Faldini et al, ; Matejovsky & Kofranek, ; Singh et al, ; Terry Canale & Beaty, ). Our in vivo model did not address the potential allograft failure under mechanical loading and our future studies will include evaluation of our allograft under loading.…”

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

“…Patients were included if aged between 18-65 years, and had a failure of plate fixation of the distal one third of the tibia with an existing non-union or malunion, whether infected or not. Malunion was defined as a coronal deformity of greater than 5 º varus or 10 º valgus, or a sagittal deformity of greater than 15 º [19]. Non-union was defined as the lack of any clinical or radiological evidence of union at six months [20].…”

Modulation of host osseointegration during bone regeneration by controlling exogenous stem cell differentiation using a material approach

“…A critically-sized femoral segmental defect mouse model was used in this study. A total of 24 immunodeficient nude mice were used as the recipients and they were randomly divided into three experimental groups based on the HA content in the Col-HA scaffold (n = 8): (1) No HA group (containing 0% HA), (2) Low HA group (containing ∼25% HA) and (3) High HA group (containing ∼45% HA). Briefly, the mice were anesthetized with a ketamine-xylazine mixture (135 mg kg −1 and 15 mg kg −1 ).…”

“…The repair of large bone defects caused by trauma, disease, or surgical intervention still remains a major challenge in the clinic. 1,2 Although autograft has been regarded as the current "gold standard" for bone defect repair, it severely suffers from a number of drawbacks such as donor site morbidity, lack of availability and the need for tissue harvest from another anatomic location. 3 Allograft as an alternative approach is also limited by its own problems such as disease transmission, immunogenicity and high failure rate.…”