Treatment of tibial nonunion with bone defect using a heterotopic ossification as autologous bone graft: literature overview and case report

  • Michael Schlumberger
  • Raul Mayr
  • Christian Koidl
  • Martin Eichinger
  • Tobias Roth
Up-to date Review and Case Report • LOWER LIMB - FRACTURES



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.


Nonunion 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.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Michael Schlumberger
    • 1
  • Raul Mayr
    • 1
  • Christian Koidl
    • 1
  • Martin Eichinger
    • 1
  • Tobias Roth
    • 1
  1. 1.Department of Trauma SurgeryUniversity Hospital InnsbruckInnsbruckAustria

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