Bone grafting of the regenerate: a previously undescribed case and surgical technique

Authors

  • Mazen` Abdalla Department of Medicine and Health Sciences, Najah National University and Hospital, Nablus, Palestine http://orcid.org/0000-0002-9837-1875
  • Konstantinos Giannikas Department of Orthopaedic Consultant, GHA Gennimatas, Athens, Greece

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20202694

Keywords:

Distraction osteogenesis, Grafting poor regenerate, Non-vascularized fibular graft, Circular external fixator, Compression and distraction

Abstract

Distraction osteogenesis can occasionally be complicated with poor-quality regenerated bone. Several factors have been identified in the literature in order to reinforce the maturation of the regenerate. We would like to present a case in a 40 years old patient who presented with shortening and uniplanar varus angulation at his proximal tibia. The patient was treated with distraction osteogenesis using a circular frame. He had significant delay in the maturation of the 4-5 cm gap, and it was decided to use a non-vascularized fibular graft that was introduced using the tibial intramedullary nailing instrumentation. The graft led to an impressive acceleration of the maturation of the regenerate, mostly posteriorly and laterally with poor progression at the anterior part of the tibia. As this is the first such case presented in the international literature it is difficult to speculate why the regenerate was stimulated only in specific areas. Further reporting is necessary to reach safe conclusions.

References

Emara KM, Ghafar KA, Kersh AMA. Methods to shorten the duration of an external fixator in the management of tibial infections. World J Orthop. 2011;2(9):85-92.

Borzunov DY, Shastov AL. Mechanical solutions to salvage failed distraction osteogenesis in large bone defect management. Int Orthop. 2019;43(5):1051-9.

Sabharwal S. Enhancement of bone formation during distraction osteogenesis: pediatric applications. J Am Acad Orthop Surg. 2011;19:101-11.

Mowafi EH, Mohsen M. The effect of low-intensity pulsed ultrasound on callus maturation in tibial distraction osteogenesis. Int Orthop. 2005;29:121-4.

Kiely P, Ward K, Bellemore CM, Cowell BJCT, Little DG. Bi-phosphonate rescue in distraction osteogenesis: a case series. J Pediatr Orthop. 2007;27:467-71.

Burkhart KJ, Rommens PM. Intramedullary application of bone morphogenic protein in the management of a major bone defect after an Ilizarov procedure. J Bone Joint Surg Br. 2008;90:806-9.

Kitoh H, Kitakoji T, Tsuchiya H, Katoh M, Ishiguro N. Distraction osteogenesis of the lower extremity in patients with achondropasia/hypochondroplasia treated with transplantation of culture-expanded bone marrow cells and platelet-rich plasma. J Pediatr Orthop. 2007;27:629-34.

Downloads

Published

2020-06-23

Issue

Section

Case Reports