Abstract
Different methods of filling bone defects are reported: shortening followed by lengthening or bone transplant. In both cases the resection and docking bone site (immediately or after transplant) has a high risk of delayed consolidation or non-union. The aim of this study was to evaluate the strategies to avoid this risk.
We studied 19 patients treated from 1997 to 2002: 11 (group 1) were treated with immediate shortening and proximal callotasis. In eight patients (group 2) we performed monofocal proximal-distal bone transplant. In seven patients of group 1 we performed only decortication of the docking site (group 1A); in four cases (group 1B) decortication was associated with an autologous bone graft. The docking site was checked radiologically and considered healed when we allowed full weight-bearing after fixator removal.
In two patients (28.5%) in group 1A, three (75%) in group 1B and two (25%) in group 2 healing was achieved without any other operations. Docking site refracture or pseudoarthrosis was treated in all patients by new decortication and autologous bone graft with an average healing time of 90 days.
We suggest performing acute bone loss shortening in combination with decortication and autologous bone graft when local conditions permit. After bone transplant it is not necessary to wait for spontaneous consolidation, but better to plan from the beginning another operation before the two the docking site fragments are in contact.
Now we are using AGF and BMP-7 (OP-1) for treatment of the docking site but the study is still underway.
