Sanjit R Konda1,2, Connor P Littlefield1, Kurtis D Carlock1, Abhishek Ganta1,2, Philipp Leucht1, Kenneth A Egol3,4. 1. NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA. 2. Jamaica Hospital Medical Center, Jamaica, NY, USA. 3. NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA. Kenneth.Egol@nyumc.org. 4. Jamaica Hospital Medical Center, Jamaica, NY, USA. Kenneth.Egol@nyumc.org.
Abstract
BACKGROUND: Tibial nonunion remains a considerable burden for patients and the surgeons who treat them. In recent years, alternatives to autogenous grafts for the treatment of tibial nonunions have been sought. The purpose of this study was to evaluate the efficacy of autogenous iliac crest bone graft (ICBG) in the treatment of tibial shaft nonunions. MATERIAL AND METHODS: Sixty-nine patients were identified who underwent ICBG for repair of atrophic or oligotrophic tibial nonunion and had complete data with at least one year of follow-up (mean 27.9 months). Surgical treatments consisted of revision/supplemental fixation ± ICBG. Surgical approaches for graft placement were either posterolateral (PL), anterolateral (AL), or direct medial (DM). Healing status, time to union, postoperative pain, and functional outcomes were assessed. RESULTS: Bony union was achieved by 97.1% (67/69) of patients at a mean time of 7.8 ± 3.2 months postoperatively. There was no significant difference in mean time to union between the three surgical approach groups: (PL (44.9%) = 7.3 months, AL (20.3%) = 9.2 months, DM (34.8%) = 7.6 months; p = 0.22). Intraoperative cultures obtained at the time of nonunion surgery were positive in 27.5% of patients (19/69). Positive cultures were associated with need for secondary surgery as 8/19 patients (42.1%) with positive cultures required re-operation. Two out of four patients that developed iliac donor site hematomas/infections requiring washout had positive intraoperative cultures as well. There was no difference in final SMFA among the three surgical approach groups. CONCLUSIONS: Autogenous ICBG remains the gold standard in the management of persistent tibial nonunions regardless of surgical approach. There is a small risk for complication at the iliac crest donor site. Given the high union rate, autogenous iliac crest bone grafting for tibial nonunion remains the gold standard for this difficult condition. LEVEL OF EVIDENCE: Level III.
BACKGROUND: Tibial nonunion remains a considerable burden for patients and the surgeons who treat them. In recent years, alternatives to autogenous grafts for the treatment of tibial nonunions have been sought. The purpose of this study was to evaluate the efficacy of autogenous iliac crest bone graft (ICBG) in the treatment of tibial shaft nonunions. MATERIAL AND METHODS: Sixty-nine patients were identified who underwent ICBG for repair of atrophic or oligotrophic tibial nonunion and had complete data with at least one year of follow-up (mean 27.9 months). Surgical treatments consisted of revision/supplemental fixation ± ICBG. Surgical approaches for graft placement were either posterolateral (PL), anterolateral (AL), or direct medial (DM). Healing status, time to union, postoperative pain, and functional outcomes were assessed. RESULTS: Bony union was achieved by 97.1% (67/69) of patients at a mean time of 7.8 ± 3.2 months postoperatively. There was no significant difference in mean time to union between the three surgical approach groups: (PL (44.9%) = 7.3 months, AL (20.3%) = 9.2 months, DM (34.8%) = 7.6 months; p = 0.22). Intraoperative cultures obtained at the time of nonunion surgery were positive in 27.5% of patients (19/69). Positive cultures were associated with need for secondary surgery as 8/19 patients (42.1%) with positive cultures required re-operation. Two out of four patients that developed iliac donor site hematomas/infections requiring washout had positive intraoperative cultures as well. There was no difference in final SMFA among the three surgical approach groups. CONCLUSIONS: Autogenous ICBG remains the gold standard in the management of persistent tibial nonunions regardless of surgical approach. There is a small risk for complication at the iliac crest donor site. Given the high union rate, autogenous iliac crest bone grafting for tibial nonunion remains the gold standard for this difficult condition. LEVEL OF EVIDENCE: Level III.
Authors: David P Taormina; Brandon S Shulman; Raj Karia; Allison B Spitzer; Sanjit R Konda; Kenneth A Egol Journal: Geriatr Orthop Surg Rehabil Date: 2014-09
Authors: Marc A Tressler; Justin E Richards; D'mitri Sofianos; F Kyle Comrie; Philip J Kregor; William T Obremskey Journal: Orthopedics Date: 2011-12-06 Impact factor: 1.390
Authors: Marc F Swiontkowski; Hannu T Aro; Simon Donell; John L Esterhai; James Goulet; Alan Jones; Philip J Kregor; Lars Nordsletten; Guy Paiement; Amratlal Patel Journal: J Bone Joint Surg Am Date: 2006-06 Impact factor: 5.284
Authors: Kenneth A Egol; Konrad Gruson; Allison B Spitzer; Michael Walsh; Nirmal C Tejwani Journal: Clin Orthop Relat Res Date: 2009-05-13 Impact factor: 4.176