Advances in the Application of Bone Transport Techniques in the Treatment of Bone Nonunion and Bone Defects

Bone nonunion and bone defects frequently occur following high-energy open injuries or debridement surgeries, presenting complex challenges to treatment and significantly affecting patients' quality of life. At present, there are three primary treatment options available for addressing bone nonunion and bone defects: vascularized bone grafts, the Masquelet technique, and the Ilizarov technique. The Ilizarov technique, also known as distraction osteogenesis, is widely favored by orthopedic surgeons because of several advantages, including minimal soft tissue requirements, low infection risk, and short consolidation time. However, in recent years, the application of the Masquelet technique has resulted in novel treatment methods for managing post-traumatic bone infections when bone defects are present. Although these new techniques do not constitute a panacea, they continue to be the most commonly employed options for treating complex large bone nonunion and bone defects. This review evaluates the currently available research on the Ilizarov and Masquelet bone transport techniques applied at various anatomical sites. Additionally, it explores treatment durations and associated complications to establish a theoretical foundation that can guide clinical treatment decisions and surgical procedures for the management of bone nonunion and bone defects.

Fibula pro tibia and cancellous allograft vitalised with autologous bone for non-union of the distal tibia diaphysis: Surgical technique

Background

The management of medium-sized osseous defects and pseudoarthrosis of the tibia is challenging. This surgical technique aims to bridge medium-sized tibial defects using the fibula as a lead structure. The fibula and cancellous bone graft fuse with the tibia leading to synostosis.

Methods

Cortico-cancellous bone is harvested from the anterior iliac crest. The bone is shredded into small pieces of about 5 mm and mixed with stem cell-rich blood from the situs. Additionally, cancellous allografts can be used for expansion. The approach is extended along the interosseous membrane to reach the tibial defect. The pseudarthrosis is debrided and the tibial bone adjacent to the defect is decorticated. A 3.5 mm 1/3 tube plate is positioned to the fibula and fixed. Four quadricortical screws are positioned. Autograft is secured into the tibial bone defect and between the fibula and the tibia directly on the anterior surface of the interosseous membrane.

Results

15 patients were followed up for a mean of 17 months. Osseous consolidation was achieved in 73.3% of all cases. On average, bone healing has occurred 17 weeks postoperatively. These patients did not have any pain walking with full weight bearing and without any walking aids at the last follow-up.

Conclusion

The fibula pro tibia procedure is a sufficient tool for treating non-unions of the mid and distal third of the tibia diaphysis in cases with a bony defect size of 1 cm-6 cm.

A Novel Technique-Bone Splitting and Bone Grafting in an Hourglass-shaped Bone Following Distraction Osteogenesis

Aim

We describe a novel technique of bone splitting and bone grafting in managing hypoplastic or hourglass-shaped regenerated bone in distraction osteogenesis.

Background

Hourglass-shaped regenerated bone is a potential complication during distraction osteogenesis which is vulnerable to fracture when loaded. Our novel technique overcomes this by increasing the diameter of new bone formation via bone splitting and bone grafting.

Case description

We report three cases with hypoplastic regenerated bone following distraction osteogenesis. It was treated with bone splitting and bone grafting. Although one case was complicated with an iatrogenic transverse fracture during the surgery, all three cases achieved the goal of increasing bone diameter during the subsequent consolidation phase.

Conclusion

This relatively simple and novel surgical intervention can overcome the hourglass-shaped appearance, thus preventing potential fracture.

Clinical significance

We emphasise the importance of identifying hypoplastic regenerate bone before the consolidation phase of distraction osteogenesis. The novel technique described is a simple surgical intervention which can prevent potential fracture through the newly formed bone.

How to cite this article

Lee HS, Tasarib R, Hamzah FC, et al. A Novel Technique—Bone Splitting and Bone Grafting in an Hourglass-shaped Bone Following Distraction Osteogenesis. Strategies Trauma Limb Reconstr 2020;15(3):175–178.