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


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.
Ateschrang
Atesch
A
Berufsgenossenschaftliche Unfallklinik Tübingen der Eberhard-Karls Universität Tübingen, Abteilung für Unfall- und Wiederherstellungschirurgie, Schnarrenbergstr. 95, 72076, Tübingen, Germany. ate21@gmx.de
Ochs
Björn Gunnar
BG
Lüdemann
Martin
M
Weise
Kuno
K
Albrecht
Dirk
D
D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D016025:Bone Transplantation; D005260:Female; D005360:Fibula / Q000293:injuries / Q000601:surgery*; D005599:Fractures, Ununited / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000601:surgery*; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D055815:Young Adult