Abstract
Background
Nonunion of long bones in lower limbs is a common complication of orthopedic trauma that can be extremely debilitating. This retrospective study describes our experience using expandable intramedullary nails and autologous bone grafting in treating lower limb long bone nonunion with bone defects.
Methods
Nineteen patients (mean age 38.9 years, range 18–61) with lower limb long bone nonunion and defects caused by femoral or tibial fracture types were as follows: A2 (3 femoral, 1 tibial), A3 (1 femoral, 2 tibial), B2 (3 femoral, 4 tibial), and B3 (1 femoral, 4 tibial). Expandable intramedullary nailing and autologous bone (iliac and/or fibular) grafting were used for the treatment. Postoperative bone healing as determined by analysis of standard anteroposterior and lateral X-ray films every 4 weeks. Complications were noted.
Results
The average number of previous surgeries was 1.9 (range 1–4). The mean duration from original injury to treatment was 17.6 months (range 9–40 months). Femoral shaft nonunion healed on average of 26.5 weeks (range 16–60 weeks) after surgery, while tibial shaft nonunion healed on average of 23.6 weeks (range 12–40 weeks) after surgery. Class I healing occurred in all but two patients who experienced chronic postoperative osteomyelitis and delayed wound healing, respectively. Two patients complained of postoperative donor site pain.
Conclusions
The use of expandable intramedullary nails and autologous bone grafts was an effective method for repair of nonunion of lower limb fractures combining with bone defects with minimal complications.
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References
Pugh DM, McKee MD (2003) Advances in the management of humeral nonunion. J Am Acad Orthop Surg 11:48–59
Schmidt AH, Finkemeier CG, Tornetta P III (2003) Treatment of closed tibial fractures. Instr Course Lect 52:607–622
Rosen H (1990) The treatment of nonunions and pseudarthroses of the humeral shaft. Orthop Clin North Am 21:725–742
Bach AW, Hansen ST Jr (1983) Delayed union, nonunion, and malunion of the tibial shaft. In: Evans CM (ed) Surgery of the musculoskeletal system. Churchill Livingstone, New York
Blachut PA, Meek RN, O’Brien J (1991) Delayed intramedullary nailing following external fixation of open tibial shaft fractures: a sequential protocol. J Orthop Trauma 5:239
Patil S, Montgomery R (2006) Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. J Bone Joint Surg Br 88:928–932
Pihlajamaki HK, Salminen ST, Bostman OM (2002) The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma 16:394–402
Chin KR, Nagarkatti DG, Miranda MA et al (2003) Salvage of distal tibia metaphyseal nonunions with the 90 degrees cannulated blade plate. Clin Orthop Relat Res 409:241–249
Paley D, Chaudray M, Pirone AM et al (1990) Treatment of malunions and mal-nonunions of the femur and tibia by detailed preoperative planning and the Ilizarov techniques. Orthop Clin North Am 21:667–691
Templeman D, Thomas M, Varecka T et al (1995) Exchange reamed intramedullary nailing for delayed union and nonunion of the tibia. Clin Orthop Relat Res 315:169–175
Hierholzer C, Sama D, Toro JB et al (2006) Plate fixation of ununited humeral shaft fractures: effect of type of bone graft on healing. J Bone Joint Surg Am 88:1442–1447
Helfet DL, Jupiter JB, Gasser S (1992) Indirect reduction and tension-band plating of tibial non-union with deformity. J Bone Joint Surg Am 74:1286–1297
Court-Brown CM, Keating JF, Christie J et al (1995) Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg Br 77:407–411
Mayo KA, Benirschke SK (1990) Treatment of tibial malunions and nonunions with reamed intramedullary nails. Orthop Clin North Am 21:715–724
Wu CC, Chen WJ (2002) Exchange nailing for aseptic nonunion of the femoral shaft. Int Orthop 26:80–84
Daccarett BM, Walz BM, Seligson D (2004) Use of an expandable nail in the treatment of non-union fractures of the femur, tibia and humerus. J Orthop Traumatol 12:130–134
Steinberg EL, Keynan O, Sternheim A et al (2009) Treatment of diaphyseal nonunion of the femur and tibia using an expandable nailing system. Injury 40:309–314
Niu Y, Xu S, Li M et al (2009) Expandable intramedullary nailing for treatment of atrophic femoral shaft nonunion associated with hypotoxic infection and bone defects: a case report. Injury Extra 40:255–258
Galasso O, Mariconda M, Romano G et al (2008) Expandable intramedullary nailing and platelet rich plasma to treat long bone non-unions. J Orthop Traumatol 9:129–134
Blum J, Janzing H, Gahr R et al (2001) Clinical performance of a new medullary humeral nail: antegrade versus retrograde insertion. J Orthop Trauma 15:342–349
Blum J, Karagul G, Sternstein W et al (2005) Bending and torsional stiffness in cadaver humeri fixed with a self-locking expandable or interlocking nail system: a mechanical study. J Orthop Trauma 19:535–542
Pascarella R, Nasta G, Nicolini M et al (2002) The Fixion nail in the lower limb. Preliminary results. Chir Organi Mov 87:169–174
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Y. Niu and Y. Bai equally contributed to the paper.
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Niu, Y., Bai, Y., Xu, S. et al. Treatment of lower extremity long bone nonunion with expandable intramedullary nailing and autologous bone grafting. Arch Orthop Trauma Surg 131, 885–891 (2011). https://doi.org/10.1007/s00402-010-1226-9
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DOI: https://doi.org/10.1007/s00402-010-1226-9