title: Treatment of infection and non-union after bilateral complicated proximal tibial fracture.
abstract: OBJECTIVE
  Complicated tibial fractures form a great challenge for orthopaedic surgeons. Non-unions and infections are more common in complicated than in closed fractures. In the present study, we describe a patient case treated for non-union combined to chronic osteomyelitis after bilateral open proximal tibial fractures.
  
  
  METHODS
  A female patient born in 1946 was multi-traumatised, when a car hit her as a pedestrian. She went through multiple operations of both tibias due to bilateral complicated proximal fractures. Fractures were stabilised at first with internal fixation, which had to be changed to external fixation due to infection of both sides. During the last operative step a commercial bone graft based on hydroxyapatite and bovine type I fibrillar collagen/tricalcium phosphate ceramic (Collagraft) mixed with autogenous bone marrow was applied.
  
  
  RESULTS
  Fractures united after 28 (right tibia) and 22 (left tibia) months of follow-up. At the final follow-up visit 55 months after the initial accident patient walked without any aid and showed no signs of an infection.
  
  
  CONCLUSIONS
  The use of commercial mixed xeno-/autogenous-bone graft may provide a feasible alternative in complicated chronic non-unions of the tibia even when an infection is present, especially when autogenous bone is not easily available after previous attempts of bone grafting.
authors.affiliation: Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Finland. jan.lassus@soy-foa.org
authors.forename: J
authors.initials: J
authors.lastname: Lassus
authors.forename: I
authors.initials: I
authors.lastname: Tulikoura
authors.forename: Y T
authors.initials: YT
authors.lastname: Konttinen
authors.forename: S
authors.initials: S
authors.lastname: Santavirta
mesh_terms: D002130:Calcium Phosphates / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D005592:Fracture Fixation; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009104:Multiple Trauma; D010019:Osteomyelitis / Q000209:etiology*; D011183:Postoperative Complications / Q000628:therapy*; D019736:Prostheses and Implants; D011859:Radiography; D013978:Tibial Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D002130:Calcium Phosphates; C065819:Collagraft; D003094:Collagen