DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20183010

Results of bridging LCP along with corticocancellous autogenous bone graft and calcium hydroxyapatite blocks in gap nonunion of long bones

Ankur Agarwal

Abstract


Background: High-energy trauma is an important cause of compound fractures of long bones that in turn results into bone gap due to bone loss or high communition with resultant displacement of minute fracture fragments and hence non-union. Bone resorption or surgical excision for infection or tumour also leads to gap non-unions.

Methods: Forty-one patients having fracture of long bones of extremities with a bone gap of upto 2 inches were enrolled and were treated with autogenous bone grafting and calcium hydroxyapatite (CHA) blocks along with fixation by a locked compression plate (LCP) and plaster slab. The average follow-up period was ten months. One patient was excluded from the study due to drop out from follow up.

Results: In 23 (57.5%) patient’s radiological union occurred by 24-26 weeks. In 16 (40%) patients, radiological union was seen between 26-28 weeks, while in one (2.5%) patient union was seen at 30 weeks. Also, it was seen that smaller the length of gap, the faster was the union. Excellent results were seen in the majority of 25 patients (62.5%), good results in 11 patients (27.5%), fair results in 3 patients (7.5%) and poor outcome in 1 patient (2.5%). Also, it was seen that smaller the gap size, better was the outcome.

Conclusions: The technique of bridge plating using internal fixator i.e. LCP along with autogenous corticocancellous bone graft and CHA blocks is a fairly good technique to treat gap non unions. It has its own advantages of avoiding complications associated with large external frame constructs. However, larger gap size limits the usefulness of this technique.


Keywords


Gap nonunion, Calcium hydroxyapatite, Locked compression plating, Corticocancellous bone grafting

Full Text:

PDF

References


Farmanullah A, Khan MS, Awais SM. Evaluation of Management of Tibial Non-Union Defect with Ilizarov Fixator. J Ayub Med Coll Abbottabad. 2007;19(3):14-7.

Atesalp AS, Basbozkurt M, Erler K, Sehirlionğlu A, Tunay S, Solakoğlu C, Gür E. Treatment of Tibial Bone Defects with the Ilizarov Circular External Fixator in High Velocity Gunshot Wounds. International Orthopaedics. 1998;22(6):343-7.

Shasha N, Krywulak S, Backstein D, Pressman A, Gross AE. Long-term followup of fresh tibial osteochondral allografts for failed tibial plateau fractures. J Bone Joint Surg Am. 2003;85(2):33-9.

Keating JF, Simpson AH, Robinson CM. The management of fractures with bone loss. J Bone Joint Surg Br. 2005;87(2):142-50.

Sadat-Shojai M. Hydroxyapatite: inorganic nanoparticles of bone. 1st Ed. Tehran: Iranian Students Book Agency (ISBA); 2010.

Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Clin Orthop Relat Res. 1989;(239):263-85.

Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res. 1989;241:146-65.

Green SA, Jackson JM, Wall DM, Marinow H, Ishkanian J. Management of Segmental Defects by the Ilizarov Intercalary Bone Transport Method. Clin Orthop Relat Res. 1992;280:136-42.

Abdel-Aal AM. Ilizarov bone transport for massive tibial bone defects. Orthopedics 2006;29(1):70-4.

Naggar L, Chevalley F, Blanc CH, Livio JJ. Treatment of large bone defects with the Ilizarov technique. J Trauma. 1993;34(3):390-3.

Paley D. Problems, Obstacles and complications of limb lengthening by Ilizarov technique. Clin Orthop. 1990;250:81-104.

Charalambous CP, Akimau P, Wilkes RA. Hybrid monolateral-ring fixator for bone transport in post-traumatic femoral segmental defect: a technical note. Arch Orthop Trauma Surg. 2009;129:225–6.

Kocaoglu M, Eralp L, Rashid HU, Sen C, Bilsel K. Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. J Bone Joint Surg Am. 2006;88:2137–45.

Raschke MJ, Mann JW, Oedekoven G, Claudi BF. Segmental transport after unreamed intramedullary nailing: preliminary report of a “Monorail” system. Clin Orthop Relat Res. 1992;282:233–40.

Arora S, Batra S, Gupta V, Goyal A. Distraction osteogenesis using a monolateral external fixator for infected non-union of the femur with bone loss. J Orthop Surg (Hong Kong). 2012;20(2):185-90.

Masquelet AC, Fitoussi F, Beguet, Muller GP. Reconstruction of the long bone by the induced membrane and spongy autograft. Ann Chirp Plast Esthet. 2000;45:346-53.

Tamaki S, Ichinohe T, Matsuo K, Hamajima N, Hirabayashi N, Dohy H. Superior survival of blood and marrow stem cell recipients given maternal grafts over recipients given paternal grafts. Bone Marrow Transplant. 2001;28(4):375-80.

Johnson EE, Urist MR, Finerman GA. Resistant nonunions and partial or complete segmental defects of long bones: treatment with implants of a composite of human bone morphogenetic protein (BMP) and autolyzed, antigen-extracted allogeneic (AAA) bone. Clin Orthop. 1992;277:229-37.

Natarajan MV, Govardhan RH, Williams S, Raja Gopal TS. Limb salvage surgery for pathological fractures in osteosarcoma. International Orthopaedics. 2000;24(3):170-2.

Miller RC, Phalen GS. The repair of defects of the radius with fibular bone grafts. J Bone Joint Surg Am. 1947;29:629-36.

Spira E. Bridging of bone defects in the forearm with iliac graft combined with intramedullary nailing. J Bone Joint Surg Br. 1954;36:642-6.

Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am. 1980;62:1039-58.

Matsushita T, Watanabe Y. Chipping and lengthening technique for delayed unions and nonunions with shortening or bone loss. J Orthop Trauma. 2007;21(6):404-6.

Khan AS, Shoaib M, Khan J, Darain H, Arsh A. Outcome of Chipping Method in Complex Non-Union of Long Bones. JIMDC. 2017;6(3):121-4.

Huntington TW. VI. Case of Bone Transference: Use of a Segment of Fibula to Supply a Defect in the Tibia. Ann Surg. 1905;41(2):249- 51.

Tuli SM. Tibialization of the fibula: a viable option to salvage limbs with extensive scarring and gap nonunions of the tibia. Clin Orthop Relat Res. 2005;431:80-4.

Catagni MA, Camagni M, Combi A, Ottaviani G. Medial fibula transport with the Ilizarov frame to treat massive tibial bone loss. Clin Orthop Relat Res. 2006;448:208-16.

Nicoll EA. The treatment of gaps in long bones by cancellous insert grafts. J Bone Joint Surg Br. 1956;38-B:70-82.

Grace TG, Eversman WW Jr. The management of segmental bone loss associated with forearm fractures. J Bone Joint Surg Am. 1980;62:1150-5.

Hansis M, Duffner F, Weller S. Surgical treatment of aseptic forearm shaft pseudarthrosis. Aktuelle Traumatol. 1989;19:192-5.

Ring D, Jupiter JB, Quintero J, Sanders RA, Marti RK. Atrophic ununited fractures of the humerus with a bony defect: treatment by wave-plate osteosynthesis. J Bone Joint Surg Br. 2000;82:867-71.

Brunner CF, Weber BG. Special techniques in internal fixation. Telger TC, translator. New York: Springer; 1982. Blatter G, Weber BG. Wave plate osteosynthesis as a salvage procedure. Arch Orthop Trauma Surg. 1990;109:330-3.

Gautier E. Concepts of Bridge Plating using AO Locked Compression Plate. AO Dialogue 2. 2009: 24-27.

Kawakami R, Konno S, Ejiri S, Hatashita S. Surgical treatment for infected long bone defects after limb-threatening trauma: application of locked plate and autogenous cancellous bone graft. Fukushima J Med Sci. 2015;61(2):141–8.

Klemm KW, Borner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res. 1986;(212):89-100.