Clinical outcomes of autogenous cancellous tibial bone graft obtained from tibial condyles through the portal for tibial nailing

Abstract

Autogenous bone grafting is a common treatment of choice for bonedefect, or nonunion in lower extremities, including tibial fracture. Theiliac crest is the most popular bone donor site. However, it iscumbersome to prepare the operation involving the iliac crest due to thedistance from the lower extremity operation field. Also, donorsite-related complications should be of concern. The purpose of thisstudy is to introduce and review clinical outcomes of a new techniqueharvesting tibial autogenous cancellous bone grafts in association withintramedullary (IM) tibial nailing.We retrospectively reviewed twenty-two patients who receivedautogenous cancellous bone grafts obtained from the entry of IM tibialnail for fracture gap, malalignment, and nonunion in upper and lowerextremities. All of the patients were to receive IM nailing or had already received IM nailing for the fixation of an ipsilateral tibia shaft fracture.Through the follow-up, we reviewed postoperative complications relatedto the bone harvest and union time. Nonparametric Mann-Whitney testswere used to compare Knee pain (VAS: visual analogue scale) andfunction (Lysholm knee score) between the study group and the controlgroup. During the follow-up period, there were no complicationsassociated with the bone donor site such as hematoma, infection, andtibial plateau fracture. On the recipient site, a bone union was completedin all patients at an average of 6 months. At their last follow-up, theaverage VAS was 1.27 (0-5), which was not significantly different fromthe control group (VAS: 1.14) (p = 0.521). Also, there was no significantdifference in the Lysholm knee score compared to the control group (p =0.412).By using the bone grafts harvested from the entry point of a tibialintramedullary nail, the operation can be conveniently prepared and canbe performed safely without additional morbidity.