title: Treatment of atrophic tibia non-unions according to 'diamond concept': Results of one- and two-step treatment.
abstract: BACKGROUND
  The successful treatment of atrophic tibia non-unions and tibia non-unions with large bone defects or infections is a major challenge in orthopedic and trauma surgery. This article evaluates the use of the 'diamond concept' using a one-step or two-step procedure according to 'Masquelet technique' in the treatment of atrophic tibia non-unions.
  
  
  METHODS
  Between February 2010 and March 2014, 102 patients with atrophic non-unions were treated according to the 'diamond concept' in our center. Ninety-nine were available for follow-up. Forty-nine received a one-step treatment (Group 1, G1) and 50 patients received a two-step treatment according to the 'Masquelet technique' (Group 2, G2). Clinical and radiological parameters were measured preoperatively as well as 4, 6, and 12 weeks and 6 and 12 months postoperatively. In order to evaluate the subjective health of patients, we used the SF-12 questionnaire. Data analysis was performed one year after treatment.
  
  
  RESULTS
  The rate of consolidation in G1 was 84% and 80% in G2. The time to heal in G2 was 8.6 ± 2.9 months, which is significantly longer than in G1 being 6.9 ± 3.1 months. In comparison patients in G1/G2 had an average of 3.2/6.7 previous major surgeries. In G1, 4 of 8 patients who did not heal successfully showed positive intraoperative cultures. In G2, 26 patients (52%) initially presented with positive cultures. The results of the SF-12 questionnaire improved in both groups during the postoperative follow-up, but showed no significant differences between groups. In 29 patients a gentamycin-coated nail was used for reosteosynthesis. These patients showed by trend a lower rate of complications at a higher rate of consolidation.
  
  
  CONCLUSIONS
  Our study showed that the 'diamond concept' is a suitable method for safely and effectively treating non-unions with large defects or infections. The use of an antibiotic-coated nail provides a therapeutic benefit. For large bone defects of infected non-unions the two-step procedure after Masquelet is an efficient way to eradicate the infection and treat the bone defect successfully.
authors.affiliation: HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany. Electronic address: arash.moghaddam@med.uni-heidelberg.de.
authors.forename: Arash
authors.initials: A
authors.lastname: Moghaddam
authors.affiliation: HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany.
authors.forename: Severin
authors.initials: S
authors.lastname: Zietzschmann
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schmidmaier
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D055419:Bone Morphogenetic Protein 7 / Q000008:administration & dosage; D001858:Bone Nails; D016025:Bone Transplantation / Q000379:methods*; D002146:Bony Callus / Q000187:drug effects; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000473:pathology / Q000628:therapy*; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000517:prevention & control / Q000628:therapy*; D011446:Prospective Studies; D012086:Reoperation; D013530:Surgical Wound Infection / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013977:Tibia / Q000098:blood supply / Q000293:injuries / Q000473:pathology*; D013978:Tibial Fractures / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D055419:Bone Morphogenetic Protein 7; D005839:Gentamicins
keywords: BMP-7; ETN PROtect™; Masquelet; RIA; Reamer-Irrigator-Aspirator; non-union; ‘diamond concept’