Management of Stiff Hypertrophic Nonunions by Distraction Osteogenesis

Abstract

Hypertrophic nonunions can be managed successfully with distraction. The Ilizarov device can address every aspect of a stiff hypertrophic nonunion, including shortening and deformity.

Management of hypertrophic nonunion with failure of internal fixation by distraction osteogenesis

“…In their opinion, hypertrophic nonunion tissue can serve as a reservoir of mesenchymal cells, which can be induced to stimulate union, without the need for directly treating the nonunion site, if abundant vascularity and stabilisation of the fracture site can be ensured [1]. The hypertrophic changes at the nonunion site reflect the intrinsic callus-forming ability and biologic healing potential of the tissue [5,14,15]. In such cases, the mechanical environment should be managed such that it is conducive to callus formation, remodeling, and consolidation.…”

“…Catagni et al [14] have shown that the Ilizarov method could be successfully used to treat fracture nonunion with chronic bone sepsis. In the Ilizarov method, the increased vascularity occurring during distraction promotes the healing of the infection and the small sequestra are assimilated in the process of active osteogenesis [15]. Chronic infection subsides with the process of regeneration of the tissue.…”

“…The required proximal or distal retraction of the skin was achieved to avoid skin tension and facilitate the correction of the deformity and limb lengthening. Further, two hinges and a motor unit were adjusted such that they were placed at the convex site of the deformity and in the bisector line, which divides the true angle of the deformity into two equal halves; this was to ensure normal lengthening during the correction of the deformity [15]. In cases of tibial nonunion, one transfixation wire each was inserted to fix the proximal and distal tibiofibular joints to prevent subluxation during correction and lengthening.…”

“…The Ilizarov method has been recommended in the treatment of fractures of the long bones with nonunion [14], particularly hypertrophic nonunion, nonunion with bone loss, and nonunion with infection [8,9,[15][16][17][18][19]. In cases of hypertropic nonunion, the Ilizarov apparatus offers the advantages of stable fixation and controlled interfragmentary compression and distraction, which stimulate callus formation, without compromising the blood supply [10].…”

Comparison of Ilizarov and rail fixator in non union of long bones

“…20,21 Average shortening present in the limb was 2.9cm in Ilizarov group 14 compared to 2.86 cm in Rail fixator group. 22 12 patients underwent acute docking or compression in ilizarov group compared to 13 in rail fixator group. 2 patients underwent compression -distraction for treatment of non union in Rail fixator group compared to 3 patients in Ilizarov group.…”