title: Tricortical bone grafts for treatment of malaligned tibias and fibulas.
abstract: Malunions and malaligned nonunions of the tibia and fibula after fracture alter limb function and can be corrected only with surgical intervention. We sought to determine whether using tricortical portions of the iliac crest in conjunction with osteotomy and internal fixation could successfully treat malunions and malaligned nonunions of the tibia and fibula. Seventeen patients with either a malunion or a malaligned nonunion of the tibia or fibula were treated with an osteotomy, deformity correction, and placement of an autogenous iliac crest tricortical bone graft with open reduction and internal fixation (ORIF). The minimum followup was 3 months (average, 32 months; range, 3-118 months). Sixteen patients (94%) had clinical and radiographic evidence of healing at an average of 99 days (range, 43-229 days). Major complications occurred in four patients; one had a persistent nonunion, two had wound infections, and one underwent resection of the distal fibula for subsequent development of fibulotalar arthrosis after ankle arthrodesis. Minor complications occurred in two patients, one tendinitis and one persistent malunion. There were no complications at the iliac crest bone graft site. Autogenous iliac crest tricortical bone grafts, when used in conjunction with correction of alignment and stable internal fixation, are a reasonable option for treatment of nonunions and malaligned nonunions of the tibia and fibula.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, WA4.312, Dallas, TX 75390-8883, USA. joseph.borrelli@utsouthwestern.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Borrelli
authors.forename: Stéphane
authors.initials: S
authors.lastname: Leduc
authors.forename: Ronald
authors.initials: R
authors.lastname: Gregush
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
mesh_terms: D000328:Adult; D016025:Bone Transplantation; D005260:Female; D005360:Fibula / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011183:Postoperative Complications; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*