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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 4, 522-529.
doi: 10.1302/0301-620X.91B4.21399  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Central bone grafting for nonunion of fractures of the tibia

A RETROSPECTIVE SERIES

M. Ryzewicz, MD, Orthopaedic Surgeon1; S. J. Morgan, MD, FACS, Associate Professor2; E. Linford, MS, Medical Student2; J. I. Thwing, MD, Resident Physician3; G. V. P. de Resende, MD, Orthopaedic Surgeon4; and W. R. Smith, MD, Professor2

1 Department of Orthopaedic Surgery Bay Area Medical Center, 3117 Shore Drive, Marinette, Wisconsin 54143, USA.
2 Department of Orthopaedic Surgery Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, Colorado 80204, USA.
3 4770 Buford Highway MSF-22, Atlanta, Georgia 30341, USA.
4 Department of Orthopaedic Surgery Hospital RIO-Laranjeiras, Rua das Laranjeiras 72, Rio de Janeiro, Rio de Janeiro 22230-070, Brazil.

Correspondence should be sent to Dr M. Ryzewicz; e-mail: Mark_Ryzewicz{at}hotmail.com

Nonunion of the tibia associated with bone loss, previous infection, obliteration of the intramedullary canal or located in the distal metaphysis poses a challenge to the surgeon and significant morbidity to patients. We retrospectively reviewed the records of 24 patients who were treated by central bone grafting and compared them to those of 20 who were treated with a traditional posterolateral graft. Central bone grafting entails a lateral approach, anterior to the fibula and interosseous membrane which is used to create a central space filled with cancellous iliac crest autograft. Upon consolidation, a tibiofibular synostosis is formed that is strong enough for weight-bearing. This procedure has advantages over other methods of treatment for selected nonunions.

Of the 24 patients with central bone grafting, 23 went on to radiographic and clinical union without further intervention. All healed within a mean of 20 weeks (10 to 48). No further bone grafts were required, and few complications were encountered. These results were comparable to those of the 20 patients who underwent posterolateral bone grafting who united at a mean of 31.3 weeks (16 to 60) but one of whom required below-knee amputation for intractable sepsis.

Central bone grafting is a safe and effective treatment for difficult nonunions of the tibia.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General