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Treatment of tibial nonunion with posterolateral bone grafting

机译：用后侧骨移植治疗胫腓骨

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Abstract Objectives Posterolateral bone grafting to treat nonunions of the distal two-thirds of the tibia avoids the often traumatized and more tenuous anterior soft-tissue envelope. Few modern reports of its effectiveness are available. We assessed whether posterolateral bone grafting leads to high union and low complication rates. Methods We conducted a retrospective review at a Level I trauma center. Our study group was 59 patients with distal two-thirds tibial fractures treated with posterolateral bone grafting. Patients included those with history of deep surgical site infection (SSI) before bone grafting (n=17), established nonunions (n=42), and impending nonunions associated with open fractures and bone gaps (n=17). All patients were followed for a minimum of 12 months unless they achieved union before that time point. Our primary outcome measurement was fracture union. Secondary outcome measurements were any complication associated with the approach and infection requiring return to the operating room. Results Fracture union was achieved in 44 (75%) of 59 patients without further intervention. The mean interval to union was 9.9 months (range, 3–22). Of 11 infected nonunions treated, nine progressed to union. Seventeen of 23 patients with defects >2cm, including defects up to 5.4cm without infection, were successfully treated. Two patients who underwent grafting at least 10 years after initial injury achieved union. No complications were associated with the approach (specifically, no wound breakdown, vascular injury, or tendon injury). Fourteen percent of patients experienced SSI after bone grafting. Seven of eight deep SSI occurred in patients with previous infection or positive intraoperative cultures. Only one (3%) of 36 patients without infection pre- or intraoperatively experienced SSI. Conclusions Even in this relatively difficult patient cohort that included large bone gaps and history of infection, union was achieved at a relatively high rate with posterolateral bone graft. The approach seems to be safe, considering no known complications specifically associated with the approach occurred, and seems to reduce the risk of SSI in the absence of previous infection. ]]>
机译：摘要目标骨骨移植治疗胫骨远端三分之二的非避免避免了经常受伤和更脆弱的前型软组织包络。很少有现代报告可用。我们评估了后侧骨嫁接是否导致高结合和低并发症率。方法我们在I级Trauma中心进行了回顾性审查。我们的研究组是59例患有后侧骨嫁接治疗的远端三分之二的胫骨骨折。患者在骨移植前（n = 17）之前，患者患有深层外科部位感染（SSI）的历史，建立的壬酮（n = 42），以及与开放骨折和骨间隙相关的undulions（n = 17）。除非在该时间点之前实现联盟，否则所有患者均持续至少12个月。我们的主要结果测量是骨折联盟。次要结果测量是与需要返回手术室的方法和感染相关的任何并发症。结果骨折结合在44（75％）的59名患者中实现，无需进一步干预。联合的平均间隔为9.9个月（范围，3-22）。在治疗的11个感染的unulions中，九个进展到联盟。成功地治疗了23例缺陷患者的23例缺陷患者> 2cm，缺陷高达5.4厘米，未经感染。两名患者在初始损伤后至少10年接受嫁接结合。没有任何并发​​症与方法（特别是没有伤口分解，血管损伤或肌腱损伤）有关。十四名患者在骨移植后经历了SSI。患有先前感染或阳性术中培养的患者中八个深度SSI中有7例。只有一（3％）的36名没有感染的患者或术中经历了SSI。结论即使在这种相对困难的患者群体中包括大的骨差距和感染史，也以相对高的速率与后侧骨移植术实现。该方法似乎是安全的，考虑到没有明确与该方法有关的已知并发症，并且似乎在没有先前感染的情况下降低SSI的风险。 ]]>

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