Extremity nonunion treated by modified autologous iliac grafting

Abstract

Objective To observe the efficacy of treating extremity nonunions by modified autologous iliac grafting.Methods Included in this study were 60 patients who had been treated for extremity nonunion in our department between May 2010 and May 2011.They were 45 men and 15 women,with an average age of 39.2 years (range,13 to 68 years).There were 7 humeral nonunions,19 tibial nonunions,27 femoral nonunions,4 radial nonunions,and 3 clavicle nonunions; by Weber classification,there were 3 hypertrophic nonunions,15 atrophic nonunions,37 ischemic nonunions and 5 pseudarthroses.The mean disease course of nonunion was 12.5 months (from 6 to 25 months).Before this revision,42 patients had one operation,17 had 2 operations and one patient had 3 operations; 45 patients had been treated with plate,8 with intramedullary nail and 7 with external fixator.This revision was performed using modified autologous iliac grafting followed by bridging fixation with locking plate.All patients were followed to document fracture healing and complications.Results The average follow-up was 12.8 months (range,6 to 24 months).The secondary revision led to bone union in 59 cases after a mean time of 5.3 months (range,4 to 8 months).One case of femoral nonunion suffered plate breakage 6 months postoperation which had to be revised by re-grafting and reconstruction plating augmented in the grafting area.No complications like infection,deformity,leg length discrepancy and pain at the bone donating area occurred in this series.Conclusion The modified autologous iliac grafting is highly efficient in curing extremity nonunions,because it can greatly activate the bone graft and increase the conductive and osteoinductive capabilities of the bone graft. Key words: Fractures, ununited; Extremities; Bone transplantation