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

• Published in: European journal of orthopaedic surgery & traumatology Vol. 28; no. 4; pp. 741 - 746
• Main Authors: Schlumberger, Michael, Mayr, Raul, Koidl, Christian, Eichinger, Martin, Roth, Tobias
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.05.2018; Springer Nature B.V
• Subjects: Amputation; Case reports; Defects; Fractures; Infections; Injuries; Medicine; Medicine & Public Health; Skin & tissue grafts; Surgery; Surgical Orthopedics; Trauma; Traumatic Surgery; Up-to date Review and Case Report • LOWER LIMB - FRACTURES; Vertebrae; Nonunion; Bone defect; Heterotopic ossification; Open fracture; Bone graft; Tibia
• ISSN: 1633-8065; 1432-1068; 1432-1068
• DOI: 10.1007/s00590-018-2146-6

Introduction 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. Conclusion In special cases, autologous transplantation of a mature heterotopic ossification is an attractive bone graft option in treating nonunion defects.