Salvage of Distal Tibia Metaphyseal Nonunions With the 90?? Cannulated Blade Plate

Treatment of Recalcitrant Distal Tibial Nonunion Using the Descending Genicular Corticoperiosteal Free Flap

“…In fact, the reported success rates of internal fixation with blade plate and nonvascularized bone grafting in recalcitrant distal tibial nonunions are high. [13][14][15] It seems that the combination of rigid fracture fixation and the osteogenetic capacity of the corticoperiosteal flap would permit success rates in the 100% range in very difficult situations. The time necessary for bone healing in the present series (3.1 months, with 1 case taking 7 months) is longer than that described in the upper extremity.…”

Percutaneous Autologous Bone Marrow Injection in the Treatment of Distal Meta-diaphyseal Tibial Nonunions and Delayed Unions

“…4,9,10,[15][16][17][18][19] These rates of healing are comparable to the reported healing rates (78%-100%) for various internal fixation and reconstructive procedures for metaphyseal tibial nonunions. 31,[33][34][35]39 By contrast, 1 paper delivered at an orthopaedic conference reported only a 39% union rate for percutaneous injections in 46 patients with delayed union or nonunion of the tibia (n = 29), femur (n = 12), or humerus (n = 5). 43 It is uncertain how many cases in that series had undergone prior fixation, had retained surgical hardware, or had nonunions of the distal tibial metaphysis.…”

“…At 6 months after percutaneous autologous bone marrow injection, the anteroposterior radiograph (D) and CT scan (E, F) showed solid bony union, and the patient reported large improvements in pain (from 2.8/10 to 0.8/10), lower extremity disability (AAOS Lower Limb Core score 52-90), and physical function-related quality of life (SF-36 Physical Component Summary score 26-51). union persists after marrow injection, this simple technique does not preclude or interfere with subsequent treatment strategies because no bridges have been burned 31,33,34 and other operative procedures including bone grafting 38 or more extensive reconstructive techniques (Fig. 3).…”

Vitamin-D Binding Protein Does Not Enhance Healing in Rat Bone Defects: A Pilot Study

“…Large bone defects resulting from trauma, tumors, osteomyelitis, or implant loosening usually require surgical treatment because spontaneous regeneration is limited to relatively small defects. Such defects in long bones may lead to delayed union or even nonunion despite adequate surgical treatment [3,5,6,9,20]. To accelerate healing in bone defects, different induction systems have resulted in healing from 30% to 90% or more of the defects [19].…”