title: Treatment of recalcitrant, multiply operated tibial nonunions with the RIA graft and rh-BMP2 using intramedullary nails.
abstract: Nonunions of the tibia continue to present some of the most difficult challenges in orthopaedic fracture care. Whether the consequence of the initial presenting injury, co-morbidity or subsequent attempts at fixation, the biological environment is often compromised. Compounding this problem is a lack of consensus on the best approach to addressing nonunited tibia fractures, placing them at risk for multiple, and sometimes ill-informed attempts at nonunion repair. We present nine cases of recalcitrant tibial nonunions which had previously undergone 4 or more attempts at repair treated with a protocol using RIA graft, rh-BMP2 and intramedullary nail fixation.
authors.affiliation: University of Florida - Shands, Jacksonville, FL 32209, USA.
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Desai
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Bell
authors.forename: Michael
authors.initials: M
authors.lastname: Suk
mesh_terms: D000293:Adolescent; D000328:Adult; D001843:Bone Cements / Q000627:therapeutic use; D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage*; D016025:Bone Transplantation / Q000379:methods* / Q000502:physiology; D003646:Debridement / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D005599:Fractures, Ununited / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000008:administration & dosage; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods; D013978:Tibial Fractures / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000295:instrumentation / Q000379:methods; D014182:Transplantation, Autologous / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements; D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D019904:Polymethyl Methacrylate