Skip to main content
SpringerLink
Log in

Fibula and tibia fusion with cancellous allograft vitalised with autologous bone marrow: first results for infected tibial non-union

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background and aims

Autogenous bone grafting has been used in reconstructing bone defects and in stimulating fracture healing, producing high healing rates in the treatment of infected tibial non-unions. A novel therapeutic alternative is now available known as “vitalised allograft”, a cancellous bone graft procured from femoral heads from living human donors and “vitalised” through the injection of autologous bone marrow. The aim of this study is to summarise the initial results of the fibula and tibia fusion using vitalised cancellous allograft in the treatment of infected tibial non-unions.

Patients and methods

We initiated a follow-up of 15 prospective non-randomized patients who received a vitalised allograft in the treatment of infected tibial non-unions in order to produce bony union. The patients included 13 men and 2 women with an average age of 48 years. All patients received a multi-stage surgical approach. After establishing an infection-free environment, allogenic cancellous bone grafting was performed, intended as the final surgical procedure in fibula and tibia fusion. Our follow-up included a clinical and radiographic investigation of the calf in four planes. We analysed union-rate and time required for bony consolidation, as well as recurrent infections, re-fractures, potential graft-resorption, and time needed for graft and bone remodelling.

Results

With an average follow-up of 17.1 months, infection control was obtained in 14 of 15 patients, producing an infection arrest rate of 93.3%. Radiographs indicated consolidation in 11 out of 15 cases, with a union rate of 73.3%. Bone union was achieved on average in 17.1 weeks.

Conclusions

Fibula and tibia fusion with allogenic cancellous bone grafting, vitalised through autogenic bone marrow, could well become an innovative treatment option for infected tibial non-unions. We need, however, to analyse a higher number of cases over a longer follow-up period in order to assess more accurately recurrent infections and re-fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brighton CT, Friedenberg ZB, Zemsky LM, Pollis RP (1975) Direct-current stimulation of nonunion and congenital pseudarthrosis. Exploration of its clinical application. J Bone Joint Surg Am 57:368–377

    PubMed  CAS  Google Scholar 

  2. Blauth W, von Törne O (1978) “Fibula-pro-tibia-fusion” (Hahn–Brandes-Graft) in treatment of bone defects of the tibia. Z Orthop Ihre Grenzgeb 116:20–26

    PubMed  CAS  Google Scholar 

  3. Chan YS, Ueng WN, Wang CJ, Lee SS, Chao EK, Shih CH (1998) Management of small infected tibial defects with antibiotic-impregnated autogenic cancellous bone grafting. J Trauma 45:758–764

    PubMed  CAS  Google Scholar 

  4. Chen C-E, Ko J-Y, Pan C-C (2005) Results of vancomycin-impregnated cancellous bone grafting for infected tibial non-union. Arch Orthop Trauma Surg 125:369–375

    Article  PubMed  Google Scholar 

  5. Cierney GIII, Mader JT, Pennick JJ (1985) A clinical staging for adult osteomyelitis. Contemp Orthop 105:17–37

    Google Scholar 

  6. Emami A, Mjöberg B, Larsson S (1995) Infected tibial non-union. Good results after open cancellous bone grafting in 37 cases. Acta Orthop Scand 66:447–451

    Article  PubMed  CAS  Google Scholar 

  7. Esterhai JL Jr, Sennett B, Gelb H, Heppenstall RB, Brighton CT, Osterman AL, LaRossa D, Gelman H, Goldstein G (1990) Treatment of chronic osteomyelitis complicating nonunion and segmental defects of the tibia with open cancellous bone graft, posterolateral bone graft, and soft-tissue transfer. J Trauma 30:49–54

    Article  PubMed  Google Scholar 

  8. Fitzgerald RH Jr, Ruttle PE, Arnold PG, Kelly PJ, Irons GB (1985) Local muscle flaps in the treatment of chronic osteomyelitis. J Bone Joint Surg Am 67:175–185

    PubMed  Google Scholar 

  9. Friedlaender GE (1987) Current concepts review bone grafts: the basic science rationale for clinical applications. J Bone Joint Surg Am 69:786–790

    PubMed  CAS  Google Scholar 

  10. Gordon L, Chiu E (1988) Treatment of infected nonunions and segmental defects of the tibia with staged microvascular muscle transplantation and bone grafting. J Bone Joint Surg Am 70:377–386

    PubMed  CAS  Google Scholar 

  11. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analysis. J Bone Joint Surg Am 58:453–458

    PubMed  CAS  Google Scholar 

  12. Gustilo RB, Gruninger RP, Davis T (1987) Classification of type III (severe) open fractures relative to treatment and results. Orthopaedics 10:1781–1788

    CAS  Google Scholar 

  13. Harmon PH (1945) A simplified surgical approach to the posterior tibia for bone grafting and fibular transference. J Bone Joint Surg 27:496–498

    Google Scholar 

  14. Hernigou P, Mathieu G, Poignard A, Manicom O, Beaujean F, Rouard H (2005) Percutaneous autologous bone-marrow grafting for non-unions. J Bone Joint Surg Am 87:1430–1437

    Article  PubMed  Google Scholar 

  15. Ilisarow GA (1991) Treatment options for infected non-union with defects saving continuity of the bone. In: Wolter D, Zimmer W (eds) The plate osteosynthesis and concurring methods. Springer, Berlin, pp 297–331

    Google Scholar 

  16. Ilisarow GA (1992) Transosseus osteosynthesis. Springer, Berlin, pp S453–S543

    Google Scholar 

  17. Jain AK, Sinha S (2005) Infected nonunion of the long bones. Clin Orthop Relat Res 431:57–65

    Article  PubMed  Google Scholar 

  18. Jones AL, Bucholz RW, Bosse MJ, Mirza SK, Lyon TR, Webb LX, Pollak AN, Golden JD, Valentin-Opran A, for the BMP-2 evaluation in surgery for tibial trauma-allograft (BESTT-ALL) study group (2006) Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects. J Bone Joint Surg Am 88: 1431–1441

    Google Scholar 

  19. Kelly PJ, Fitzgerald RH Jr, Cabanela ME, Wood MB, Cooney WP, Arnold PG, Irons GB (1990) Results of treatment of tibial and femoral osteomyelitis in adults. Clin Orthop Relat Res 259:295–303

    PubMed  Google Scholar 

  20. Kurz LT, Grafin SR, Booth RE (1989) Harvesting autogenous iliac bone grafts: a review of complications and techniques. Spine 14:1324–1331

    Article  PubMed  CAS  Google Scholar 

  21. Meyer S, Weiland AJ, Willeneger H (1975) The treatment of infected non-union of fractures of long bones. J Bone Joint Surg Am 57:836–842

    PubMed  CAS  Google Scholar 

  22. Oldenburg D (1962) Late result of an osteomyelitic pseudarthrosis of the tibia, surgically treated by the Hahn–Brandes technique. Z Orthop Ihre Grenzgeb 96:283–285

    PubMed  CAS  Google Scholar 

  23. Papineau LJ, Alfageme A, Delcourt JP, Pilos BL (1976) Chronic osteomyelitis of leg bones: resection and bone grafting with delayed skin closure. J Bone Joint Surg Br 58:138

    Google Scholar 

  24. Patzakis LJ, Mazur K, Wilkins J, Sherman R, Holtom P (1993) Septopal beads and autogenous bone grafting for bone deficits in patients with chronic osteomyelitis. Clin Orthop Relat Res 295:112–118

    PubMed  Google Scholar 

  25. Patzakis MJ, Scilaris TA, Chon J, Holtom P, Sherman R (1995) Results of bone grafting for infected tibial non-union. Clin Orthop Relat Res 315:192–198

    PubMed  Google Scholar 

  26. Rose FR, Oreffo RO (2002) Bone tissue engineering: hope vs. hype. Biochem Biophys Res Commun 292:1–7

    Article  PubMed  CAS  Google Scholar 

  27. Schmid U, Thielemann F, Weise K, Ochs BG (2007) A novel therapeutic approach to bone replacement: vitalisation of industrial processed allogenic bone graft with autologous bone marrow. Z Orthop Unfall 145:221–229

    Article  PubMed  CAS  Google Scholar 

  28. Schultz H-J, Schmidt HGK, Jürgens C, Kortmann HR (1994) Change of method in the treatment of non-unions of the tibia complicated by infection and bone loss. Zentralbl Chir 119:714–721

    PubMed  CAS  Google Scholar 

  29. Schweiberer L, Stuetzle H, Mandelkow HK (1990) Bone transplantation. Arch Orthop Trauma Surg 109:1–8

    Article  PubMed  CAS  Google Scholar 

  30. Seiler JGIII, Johnson J (2000) Iliac crest autogenous bone grafting: donor site complications. J South Orthop Assoc 9:91–97

    PubMed  Google Scholar 

  31. Silber JS, Anderson DG, Daffner SD, Brislin BT, Leland JM, Hilibrand AS, Vaccaro AR, Albert TJ (2003) Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 28(2):134–139

    Article  PubMed  Google Scholar 

  32. Weiland AJ, Moore JR, Daniel RK (1984) The efficacy of free tissue transfer in the treatment of osteomyelitis. J Bone Joint Surg Am 66:181–193

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Tübingen der Eberhard-Karls Universität Tübingen, Abteilung für Unfall- und Wiederherstellungschirurgie, Schnarrenbergstr. 95, 72076, Tübingen, Germany

    Atesch Ateschrang, Björn Gunnar Ochs & Dirk Albrecht

  2. Orthopädische Universitätsklinik Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Martin Lüdemann

  3. Ärztlicher Direktor und Ordinarius für Unfallchirurgie der Berufsgenossenschaftlichen Unfallklinik Tübingen der Eberhard-Karls Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany

    Kuno Weise

Authors
  1. Atesch Ateschrang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Björn Gunnar Ochs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Lüdemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kuno Weise
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dirk Albrecht
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dirk Albrecht.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ateschrang, A., Ochs, B.G., Lüdemann, M. et al. Fibula and tibia fusion with cancellous allograft vitalised with autologous bone marrow: first results for infected tibial non-union. Arch Orthop Trauma Surg 129, 97–104 (2009). https://doi.org/10.1007/s00402-008-0699-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-008-0699-2

Keywords

Search

Navigation