gms | German Medical Science

Objectives: Long-term nonunion leads to patients displaying depression, anxiety, reduced psychological resilience, and other psychological traumata. Repeated treatment also represents a huge economic burden to society and the patients' families. The purpose of this study was to evaluate the outcomes and efficacy of a new technique of autogenous structural iliac crest bone grafting combined with locking compression plate (LCP) vertical fixation for aseptic recalcitrant long bone nonunion.

Methods: From July 2010 to September 2020, 36 aseptic recalcitrant long bone nonunions were treated with a bone-forming channel technique and internal LCP fixation. All the patients had received one or more failed treatments. The injury mechanism, nonunion type and duration, and prior treatments were recorded pre-operation. The nonunion ends were determined as consisting of one osteogenesis deactivation zone (scar tissue and hardened sequestrum) and two osteogenesis activation zones (normal porosis tissue). The authors used a new bone graft technique termed the bone-forming channel technique, which spans the osteogenesis deactivation zone to bridge the osteogenesis activation zones. Our method with slotting at the proximal and distal regions of the fracture and implantation of the entire structural iliac bone block with cortex and cancellous bone into the slotted area ensures a tight and accurate fit. The combination of Judet decortication and one or double LCP fixation maximized the fracture union rates. The routine treatment process included nonunion area exposure, previous implant removal, sclerotic bone debridement, LCP fixation, bone-forming channel creation, and iliac bone grafting, and a second LCP fixation when required. At follow-up, X-ray images were obtained to assess bone healing and implant failure. Visual analog scale (VAS), fracture site stability, limb function, activity, muscle strength, limb length, and complications were recorded.

Results: A total of 34 patients (24 males and 10 females) were finally enrolled, with a mean age of 49.8±12.3 years. At a mean follow-up of 35.6±22.0 months, 32 patients displayed bone union, with a healing rate of 94.1% and mean union time of 6.8±2.4 months. The VAS score was 0.7±1 at the final follow-up. The functional results showed that 19 patients were excellent, 11 patients were good, 2 patients were poor, and 2 patients did not heal.

Conclusion: Bone-forming channel technique combined with LCP vertical fixation can be an effective option to treat aseptic, recalcitrant nonunion. Complete synovial pseudarthrosis debridement and deformities correction during surgery is facilitated and long bone rotation or angular deformity can be well controlled.