Treatment of tibial nonunion with bone defect using a heterotopic ossification as autologous bone graft: literature overview and case report
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Nonunion after open fracture of the lower leg is a frequent complication with a prevalence of up to 40%. In cases with major bone defects, revision of the osteosynthesis with bone grafting is commonly performed. Until today, there is no report on treatment of a tibial nonunion with transplantation of a heterotopic ossification.
Presentation of case
We present a case of a 27-year-old male patient, who suffered from a paragliding accident with major injuries. An open fracture of the lower leg (Gustilo–Anderson IIIB) was initially treated with external fixation and vacuum-assisted closure, followed by reamed intramedullary nailing. The tibia resulted in a bone defect situation with nonunion. It was successfully treated with revision, fibular osteotomy and transplantation of a heterotopic ossification, harvested from the ipsilateral hip.
In special cases, autologous transplantation of a mature heterotopic ossification is an attractive bone graft option in treating nonunion defects.
KeywordsNonunion Bone graft Bone defect Heterotopic ossification Open fracture Tibia
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 8.Roussignol X, Sigonney G, Potage D, Etienne M, Duparc F, Dujardin F (2015) Secondary nailing after external fixation for tibial shaft fracture: risk factors for union and infection. A 55 case series. Orthop Traumatol Surg Res 101(1):89–92. https://doi.org/10.1016/j.otsr.2014.10.017 CrossRefPubMedGoogle Scholar
- 10.Binod B, Nagmani S, Bigyan B, Rakesh J, Prashant A (2016) Atrophic, aseptic, tibial nonunion: how effective is modified Judet’s osteoperiosteal decortication technique and buttress plating? Arch Orthop Trauma Surg 136(8):1069–1076. https://doi.org/10.1007/s00402-016-2488-7 CrossRefPubMedGoogle Scholar
- 12.Kusnezov N, Prabhakar G, Dallo M, Thabet AM, Abdelgawad AA (2017) Bone grafting via reamer-irrigator-aspirator for nonunion of open Gustilo–Anderson type III tibial fractures treated with multiplanar external fixator. SICOT J 3:30. https://doi.org/10.1051/sicotj/2017002 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Garland DE (1991) A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res 263:13–29Google Scholar
- 28.Macheras GA, Lepetsos P, Leonidou A, Anastasopoulos PP, Galanakos SP, Tsiridis E (2017) Results from the surgical resection of severe heterotopic ossification of the hip: a case series of 26 patients. Eur J Orthop Surg Traumatol 27(8):1097–1102. https://doi.org/10.1007/s00590-017-1980-2 CrossRefPubMedGoogle Scholar