Comparison of the efficacy of bone substitutes versus autografts in aseptic non-union of the tibia. Retrospective study of 60 patients - 26/08/26
, Thierry Judet b, Romulus Fabian Tatu c, Fabrice Gaudot dAbstract |
Background |
Reconstruction of segmental bone loss of the limbs is a surgical challenge, particularly regarding the reconstruction strategy and choice of bone graft. Several bone reconstruction techniques have been validated, but the gold standard remains bone autograft. However, in certain situations, the availability or volume of bone autograft may be insufficient. The use of bone substitutes as a replacement is debated in the treatment of segmental non-union of the tibia, and little is known about bone substitute in such circumstances. Therefore we performed a retrospective study aiming: 1) to determine whether the use of bone substitutes achieves the same rate of consolidation as the use of autografts in surgical treatment of segmental non-union of the tibia, 2) to determine differences in time to consolidation and in the occurrence of complications.
Hypothesis |
The consolidation rate of bone substitute reconstruction is equivalent to that of autograft reconstruction.
Material and methods |
Sixty patients operated for aseptic non-union of the tibia with segmental bone loss were analyzed. Forty-three were reconstructed with bone autograft (group A) and 17 with calcium triphosphate hydroxyapatite biphasic ceramic substitute (SCBHTC) (group S). Consolidation was assessed clinically and radiologically, with a minimum follow-up of 2 years. Segmental bone loss averaged 3.36 ± 1.3 cm in group A, and 3.64 ± 1.7 cm in group S (NS).
Results |
After an average follow-up of 27 months, consolidation was achieved in 91% ( n = 39/43) in group (91%) and 88% in group S ( n = 15/17) ( p = 0.08), with an average delay of 142 ± 64 days in group A and 189 ± 114 days in group S ( p < 0.01). There were 5/43 (11.6%) iterative surgeries in group A versus 4/17 (23.5%) in group S ( p < 0.05).
Discussion |
SCBHTC reconstructions of tibia bone loss appear to achieve the same bone consolidation rates as autograft techniques in segmental non-union tibia, with no risk of complication. However, autograft reconstructions achieved significantly faster consolidation than those using substitutes. The use of SCBHTC could be considered in reconstructions of segmental non-union tibia, as a second-line treatment in cases when bone autograft use is not possible.
Level of evidence |
III; retrospective case control.
Le texte complet de cet article est disponible en PDF.Keywords : Aseptic non union, Tibial shaft fractures, Autograft reconstruction, Osteoperiosteal decortication, Induced membrane technique alternative
Plan
Vol 112 - N° 5
Article 104574- septembre 2026 Retour au numéro
Article précédent
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