Treatment options for aseptic tibial diaphyseal nonunion: A review of selected studies

In aseptic tibial diaphyseal nonunions after failed conservative treatment, the recommended treatment is a reamed intramedullary (IM) nail. Typically, when an aseptic tibial nonunion previously treated with an IM nail is found, it is advisable to change the previous IM nail for a larger diameter reamed and locked IM nail (the rate of success of renailing is around 90%). A second change after an IM nail failure is also a good option, especially if bone healing has progressed after the first change. Fibular osteotomy is not routinely advised; it is only recommended when it interferes with the nonunion site. In delayed unions before 24 weeks, IM nail dynamization can be performed as a less invasive option before deciding on a nail change. If there is a bone defect, a bone graft must be recommended, with the gold standard being the autologous iliac crest bone graft (AICBG). A reamer-irrigator-aspirator (RIA) system might also obtain a bone autograft that is comparable to AICBG. Although the size of the bone defect suitable to perform bone transport techniques is a controversial issue, we believe that such techniques can be considered in bone defects > 3 cm. Non-invasive therapies and biologic therapies could be applied in isolation for patients with high surgical risk, or could be used as adjuvants to the aforementioned surgical treatments. Cite this article: EFORT Open Rev 2020;5:835-844. DOI: 10.1302/2058-5241.5.190077

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Large segmental defects in midshaft clavicle nonunion treated with autologous tricortical iliac crest bone graft

Shoulder & Elbow ◽

10.1177/17585732211064815 ◽

2021 ◽

pp. 175857322110648

Author(s):

Fleur AE van der Burg ◽

Thomas PA Baltes ◽

Peter Kloen

Keyword(s):

Internal Fixation ◽

Bone Graft ◽

Bone Defect ◽

Literature Search ◽

Iliac Crest ◽

Defect Size ◽

Iliac Crest Bone Graft ◽

Extensive Literature ◽

Dash Score ◽

Segmental Bone

Background To evaluate the use of intercalary iliac crest bone graft in the treatment of clavicle nonunion with a large segmental bone defect (3–6 cm). Methods This retrospective study evaluated patients with large segmental bone defects (3–6 cm) after clavicle nonunion, treated with open reposition internal fixation and iliac crest bone graft between February 2003 and March 2021. At follow-up the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was administered. A literature search was performed to provide an overview of commonly used graft types per defect size. Results We included five patients treated with open reposition internal fixation and iliac crest bone graft for clavicle nonunion with a median defect size of 3.3 cm (range 3–6 cm). Union was achieved in all five, and all pre-operative symptoms resolved. The median DASH score was 23 out of 100 (IQR 8-24). An extensive literature search revealed that there are no studies describing the use of an used iliac crest graft for defects larger than 3 cm. Instead, a vascularized graft was typically used to treat defects sizes between 2.5 and 8 cm. Discussion An autologous non-vascularized iliac crest bone graft can be safely used and is reproducible to treat a midshaft clavicle non-union with a bone defect between 3 and 6 cm.

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The Difference of Bovine Bone Graft and Iliac Crest Bone Graft Effect on Closure of Bone Defect in Alveolar Bone Graft in Dr. Moewardi Hospital and Panti Waluyo Hospitals, Surakarta

Indonesian Journal of Medicine ◽

10.26911/theijmed.2018.03.03.05 ◽

2018 ◽

Vol 3 (3) ◽

pp. 151-161

Author(s):

Ruzbih Bahtiar ◽

◽

Dewi Haryanti Kurniasih ◽

Untung Alifianto ◽

◽

...

Keyword(s):

Bone Graft ◽

Bone Defect ◽

Iliac Crest ◽

Alveolar Bone ◽

Iliac Crest Bone Graft ◽

Bovine Bone ◽

The Difference

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Surgical reconstruction of the anterolateral acromion with a tricortical iliac crest bone graft after extensive acromioplasty

Obere Extremität ◽

10.1007/s11678-021-00624-1 ◽

2021 ◽

Author(s):

Anna-K. Tross ◽

Philip-C. Nolte ◽

Markus Loew ◽

Marc Schnetzke ◽

Sven Lichtenberg

Keyword(s):

Case Report ◽

Bone Graft ◽

Iliac Crest ◽

Deltoid Muscle ◽

Shoulder Surgery ◽

Surgical Reconstruction ◽

Iliac Crest Bone Graft ◽

Subacromial Decompression ◽

Arthroscopic Shoulder Surgery

AbstractSubacromial decompression is one of the most frequently performed procedures in the setting of arthroscopic shoulder surgery and typically includes acromioplasty. However, the indication for acromioplasty remains a subject of debate. Possible complications involve deltoid muscle insufficiency due to an excessive removal of the anterior acromion. This case report is intended to draw attention to this particular complication and its management.

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Distal Tibia Bone Graft for Arthrodesis of the Foot and Ankle

Foot & Ankle International ◽

10.1177/107110079501600403 ◽

1995 ◽

Vol 16 (4) ◽

pp. 187-190 ◽

Cited By ~ 33

Author(s):

Marc B. Danziger ◽

Richard V. Abdo ◽

J. Elliot Decker

Keyword(s):

Bone Graft ◽

Disease Transmission ◽

Donor Site ◽

Distal Tibia ◽

Iliac Crest Bone Graft ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Foot And Ankle ◽

Ankle Motion ◽

Donor Site Pain

Forty patients since 1988 have had distal tibial bone grafting for 41 arthrodeses of the foot and ankle. Bone graft is obtained through a cortical window made just above the medial metaphyseal distal tibial flare. Average follow-up was 23.3 months. Forty of 41 arthrodesis sites fused; there was only one nonunion. There were no delayed unions. There were no complications at the donor site based on patient examination and radiographs. Ipsilateral ankle motion was not affected by the bone graft procedure. Cited complications from iliac crest bone graft include donor site pain, blood loss, heterotopic bone formation, pelvic instability, iliac hernia, infection, fracture, and deformity. Complications with allografts include disease transmission and immune response. These are avoided by using locally obtained distal tibia autograft for arthrodeses in the foot and ankle.

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