Operative Techniques in Orthopaedics
Volume 18, Issue 2 , Pages 95-107 , April 2008

Nonunion with Extensive Bone Loss: Reconstruction with Ilizarov Techniques and Orthobiologics

  • J. Tracy Watson, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to J. Tracy Watson, MD, Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, St. Louis University School of Medicine, Saint Louis University Health Science Center, 3635 Vista Avenue, 7th Floor Desloge Towers, St. Louis, MO 63110-8850

References 

  1. Paley D, Catagni MA, Argnani F, et al. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop. 1989;241:146–165
  2. Watson JT, Anders M, Moed BR. Management strategies for bone loss in tibial shaft fractures. Clin Orthop. 1995;315:138–152
  3. Cattaneo R, Catagni M, Johnson EE. The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop. 1992;280:143–152
  4. Christian EP, Bosse MJ, Robb G. Reconstruction of large diaphyseal defects, without free fibular transfer, in grade-IIIb tibial fractures. J Bone Joint Surg. 1989;71A:994–1004
  5. Harmon PH. The simplified surgical approach to the posterior tibia for bone-grafting and fibular transference. J Bone Joint Surg. 1945;27:496
  6. Maurer RC, Dillin L. Multistaged surgical management of posttraumatic segmental tibial bone loss. Clin Orthop. 1987;216:162–170
  7. Milch H. Tibiofibular synostosis for non-union of the tibia. Surgery. 1950;27:770–779
  8. Shapiro MS, Endrizzi DP, Cannon RM, et al. Treatment of tibial defects and nonunions using ipsilateral vascularized fibular transposition. Clin Orthop. 1993;296:207–212
  9. Reckling FW, Waters CH. Treatment of non-unions of fractures of the tibial diaphysis by posterolateral cortical cancellous bone-grafting. J Bone Joint Surg. 1980;62A:936–941
  10. Rhinelander FW. The normal microcirculation of diaphyseal cortex and its response to fracture. J Bone Joint Surg. 1968;50A:784–800
  11. Green SA, Moore TA, Spohn PJ. Nonunion of the tibial shaft. Orthopedics. 1988;11:1149–1157
  12. Muller ME, Thomas RJ. Treatment of nonunion in fractures of long bones. Clin Orthop. 1979;138:141–153
  13. Rosen H. Compression of long bone pseudarthroses. Clin Orthop. 1979;138:154–166
  14. Weber BG, Cech O. Pseudarthrosis: Pathophysiology, Biomechanics, Therapy, Results. New York: Grune & Stratton; 1976;
  15. Sledge SL, Johnson KD, Henley MB, et al. Intramedullary nailing with reaming to treat non-union of the tibia. J Bone Joint Surg. 1989;71A:1004–1019
  16. Tornqvist H. Tibia nonunions treated by interlocked nailing: Increased risk of infection after previous external fixation. J Orthop Trauma. 1990;4:109–114
  17. Yajima H, Tamai S, Mizumoto S, et al. Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. Clin Orthop. 1993;293:256–264
  18. Song HR, Kale A, Park HB, et al. Comparison of internal bone transport and vascularized fibula for femoral bone defects. J Orthop Trauma. 2003;17:203–211
  19. Gordon L, Chiu EJ. Treatment of infected non-unions and segmental defects of the tibia with staged microvascular muscle transplantation and bone-grafting. J Bone Joint Surg. 1988;70A:377–386
  20. Mekhail AO, Abraham E, Gruber B, et al. Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma. 2004;56:368–378
  21. Watson JT. Treatment of tibial fractures with bone loss. Tech Orthop. 1996;11:132–143
  22. Gold SM, Wasserman R. Preliminary results of tibial bone transports with pulsed low intensity ultrasound (Exogen). J Orthop Trauma. 2005;19:10–16
  23. Brighton CT, Shaman P, Heppenstall RB, et al. Tibial nonunion treated with direct current, capacitive coupling, or bone graft. Clin Orthop. 1995;321:223–234
  24. Heppenstall RB, Brighton CT, Esterhai JL, et al. Prognostic factors in nonunion of the tibia: An evaluation of 185 cases treated with constant direct current. J Trauma. 1984;24:790–795
  25. Connolly JF, Guse R, Tiedeman J, et al. Autologous marrow injection for delayed unions of the tibia. J Orthop Trauma. 1989;3:276
  26. Connolly JF, Guse R, Tiedeman J, et al. Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop. 1991;266:259–270
  27. Hernigou P, Mathieu G, Poignard A, et al. Percutaneous autologous bone-marrow grafting for nonunions (Surgical technique). J Bone Joint Surg Am. 2006;88(suppl):322–327
  28. Hernigou P, Poignard A, Beaujean F, et al. Percutaneous autologous bone-marrow grafting for nonunions (Influence of the number and concentration of progenitor cells). J Bone Joint Surg Am. 2005;87:1430–1437
  29. Lindsey RW, Wood GW, Sadasivian KK, et al. Grafting long bone fractures with demineralized bone matrix putty enriched with bone marrow: Pilot findings. Orthopedics. 2006;29:939–941
  30. Pelissier P, Martin D, Baudet J, et al. Behaviour of cancellous bone graft placed in induced membranes. Br J Plast Surg. 2002;55:596–598
  31. Attias N, Lindsey RW. Case reports: Management of large segmental tibial defects using a cylindrical mesh cage. Clin Orthop Relat Res. 2006;450:259–266
  32. DeLee JC, Heckman JD, Lewis AG. Partial fibulectomy for ununited fractures of the tibia. J Bone Joint Surg. 1981;63A:1390–1395
  33. Wiss DA, Johnson DL, Miao M. Compression plating for non-union after failed external fixation of open tibial fractures. J Bone Joint Surg. 1992;74A:1279–1285
  34. Helfet DL, Jupiter JB, Gasser S. Indirect reduction and tension-band plating of tibial non-union with deformity. J Bone Joint Surg. 1992;74A:1286–1297
  35. Goodship AE, Kenwright J. The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Joint Surg. 1985;67B:650–655
  36. Wiss DA, Stetson WB. Nonunion of the tibia treated with a reamed intramedullary nail. J Orthop Trauma. 1994;8:189–194
  37. Cierny G, Zorn KL. Segmental tibial defects, comparing conventional and Ilizarov methodologies. Clin Orthop. 1994;301:118–133
  38. Newman RJ, Francis MJ, Duthie RB. Nuclear magnetic resonance studies of experimentally induced delayed fracture union. Clin Orthop. 1987;216:253–261
  39. Rozbruch RS, Weitzman AM, Watson JT, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma. 2006;20:197–205
  40. Kocialkowski A, Marsh DR, Shackley DC. Closure of the skin defect overlying infected non-union by skin traction. Br J Plast Surg. 1998;51:307–310
  41. Lenoble E, Lewertowski JM, Goutallier D. Reconstruction of compound tibial and soft tissue loss using a traction histogenesis technique. J Trauma. 1995;39:356–360
  42. Lowenberg DW, Feibel RJ, Louie KW, et al. Combined muscle flap and Ilizarov reconstruction for bone and soft tissue defects. Clin Orthop. 1996;332:37–51
  43. Green SA, Jackson JM, Wall DM, et al. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop. 1992;280:136–142
  44. Mahaluxmivala J, Nadarajah R, Allen PW, et al. Ilizarov external fixator: acute shortening and lengthening versus bone transport in the management of tibial non-unions. Injury. 2005;36:662–668
  45. Oedekoven G, Jansen D, Raschke M, et al. The monorail system–bone segment transport over unreamed interlocking nails. Chirurg. 1996;67:1069–1079
  46. Saleh M, Rees A. Bifocal surgery for deformity and bone loss after lower limb fractures (Comparison of bone transport and compression-distraction methods). J Bone Joint Surg. 1995;77B:429–434
  47. Moroni A, Vannini F, Mosca M, et al. State of the art review: Techniques to avoid pin loosening and infection in external fixation. J Orthop Trauma. 2002;16:189–195
  48. Watson JT, Quigley K, Mudd C: Iliac aspirates for the treatment of nonunions. Abstracts of the 22nd Annual Meeting OTA. Phoenix, AZ, Oct 3-7, 2006
  49. Belthur MV, Conway JD, Jindal G. Bone graft using a new intrameduallary system. Clin Orthop Relat Res. 2008;466:2973–2980
  50. Kobbe P, Tarkin IS, Frink M, et al. Voluminous bone graft harvesting of the femoral marrow cavity for autologous transplantation (An indication for the “Reamer-Irrigator-Aspirator-” (RIA-) technique (in German)). Unfallchirurg. 2008;111:469–472
  51. Jones AL, Bucholz RW, Bosse MJ, et al. Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects (A randomized, controlled trial). J Bone Joint Surg Am. 2006;88:1431–1441
  52. Pelissier P, Masquelet AC, Bareille R, et al. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res. 2004;22:73–79
  53. Pelissier P, Boireau P, Martin D, et al. Bone reconstruction of the lower extremity: complications and outcomes. Plast Reconstr Surg. 2003;111:2223–2229
  54. Viateau V, Guillemin G, Bousson V, et al. Long-bone critical-size defects treated with tissue-engineered grafts: a study on sheep. J Orthop Res. 2007;25:741–749
  55. Schöttle PB, Werner CM, Dumont CE. Two-stage reconstruction with free vascularized soft tissue transfer and conventional bone graft for infected nonunions of the tibia: 6 patients followed for 1.5 to 5 years. Acta Orthop. 2005;76:878–883
  56. Lindsey RW, Gugala Z, Milne E, et al. The efficacy of cylindrical titanium mesh cage for the reconstruction of acritical-size canine segmental femoral diaphyseal defect. J Orthop Res. 2006;24:1438–1453
  57. Attias N, Lehman RE, Bodell LS, et al. Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates: A case report. J Orthop Trauma. 2005;19:211–216
  58. Ostermann PA, Haase N, Rübberdt A, et al. Management of a long segmental defect at the proximal meta-diaphyseal junction of the tibia using a cylindrical titanium mesh cage. J Orthop Trauma. 2002;16:597–601

PII: S1048-6666(08)00039-6

doi: 10.1053/j.oto.2008.12.001

Operative Techniques in Orthopaedics
Volume 18, Issue 2 , Pages 95-107 , April 2008

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