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Tricortical Bone Grafts for Treatment of Malaligned Tibias and Fibulas

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Clinical Orthopaedics and Related Research

Abstract

Malunions and malaligned nonunions of the tibia and fibula after fracture alter limb function and can be corrected only with surgical intervention. We sought to determine whether using tricortical portions of the iliac crest in conjunction with osteotomy and internal fixation could successfully treat malunions and malaligned nonunions of the tibia and fibula. Seventeen patients with either a malunion or a malaligned nonunion of the tibia or fibula were treated with an osteotomy, deformity correction, and placement of an autogenous iliac crest tricortical bone graft with open reduction and internal fixation (ORIF). The minimum followup was 3 months (average, 32 months; range, 3–118 months). Sixteen patients (94%) had clinical and radiographic evidence of healing at an average of 99 days (range, 43–229 days). Major complications occurred in four patients; one had a persistent nonunion, two had wound infections, and one underwent resection of the distal fibula for subsequent development of fibulotalar arthrosis after ankle arthrodesis. Minor complications occurred in two patients, one tendinitis and one persistent malunion. There were no complications at the iliac crest bone graft site. Autogenous iliac crest tricortical bone grafts, when used in conjunction with correction of alignment and stable internal fixation, are a reasonable option for treatment of nonunions and malaligned nonunions of the tibia and fibula.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, WA4.312, Dallas, TX, 75390-8883, USA

    Joseph Borrelli Jr. MD

  2. Université de Montréal Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada

    Stéphane Leduc MD, FRCSC

  3. Southern California Orthopaedic Institute, Van Nuys, CA, USA

    Ronald Gregush MD

  4. Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA

    William M. Ricci MD

Authors
  1. Joseph Borrelli Jr. MD
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  2. Stéphane Leduc MD, FRCSC
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  3. Ronald Gregush MD
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  4. William M. Ricci MD
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Corresponding author

Correspondence to Joseph Borrelli Jr. MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Borrelli, J., Leduc, S., Gregush, R. et al. Tricortical Bone Grafts for Treatment of Malaligned Tibias and Fibulas. Clin Orthop Relat Res 467, 1056–1063 (2009). https://doi.org/10.1007/s11999-008-0657-x

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  • DOI: https://doi.org/10.1007/s11999-008-0657-x

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