Lorenzo Ferdinando Da Rin De
Department of Orthopaedics, Institute Codivilla-Putti, Via Codivilla, 132043 Cortina dAmpezzo, Belluno. Italy.
J Orthop Case Rep. 2017 Nov-Dec;7(6):31-35. doi: 10.13107/jocr.2250-0685.938.
Non-unions at forearms are usually challenging and difficult to treat. If additionally, an infection is present, reconstructive surgery should be planned only after full debridement, antibiotic treatment, and confirmation, based on clinical observation and laboratory tests that the infection has subsided. Bone grafting may be required for reconstruction. The use of autogenous bone calls for a second surgical site with an increased risk of morbidity. Using bone substitutes may reduce the need for autogenous bone. Stimulating factors, such as bone marrow concentrate (BMC) and demineralized bone matrix (DBM), may be used concomitantly with bone substitutes to facilitate bone regeneration.
The present report describes the case of a 38-year-old patient whose radius was fractured in a car accident. A first surgery involved stabilizing the reduced fracture with a plate, but an infection developed, and the bone did not heal. 3 months later, a second surgery followed, involving placing an antibiotic-filled spacer. This did not cure the infection, so the spacer was replaced 3 months later, and a second antibiotic was added. The patient also began taking oral antibiotics. 6 months later, the patient underwent vascularized fibular grafting. However, the graft did not integrate, and a non-union developed. A year later, the non-union was treated by grafting autogenous bone from the iliac crest, equine bone substitute, and equine DBM, in conjunction with autologous BMC and platelet-rich plasma. At the 6-month follow-up, the bone structure appeared to be successfully reconstructed.
A graft made of a combination of materials with both biological and physical properties can be used to foster bone regeneration for the treatment ofparticularly challenging cases ofnon-unions.
前臂骨不连通常具有挑战性且难以治疗。此外，如果存在感染，只有在充分清创、抗生素治疗，并根据临床观察和实验室检查确认感染已消退后，才能计划进行重建手术。重建可能需要进行骨移植。使用自体骨需要开辟第二个手术部位，发病风险会增加。使用骨替代物可能会减少对自体骨的需求。刺激因子，如骨髓浓缩物（BMC）和脱矿骨基质（DBM），可与骨替代物同时使用，以促进骨再生。
本报告描述了一名38岁患者的病例，该患者在一次车祸中桡骨骨折。首次手术用钢板固定复位后的骨折，但发生了感染，骨未愈合。3个月后进行了第二次手术，植入了一个填充抗生素的间隔物。这并未治愈感染，因此3个月后更换了间隔物，并添加了第二种抗生素。患者还开始口服抗生素。6个月后，患者接受了带血管蒂腓骨移植。然而，移植骨未融合，形成了骨不连。1年后，通过取自髂嵴的自体骨、马骨替代物和马DBM，结合自体BMC和富血小板血浆对骨不连进行了治疗。在6个月的随访中，骨结构似乎已成功重建。
由具有生物学和物理特性的材料组合制成的移植物可用于促进骨再生，以治疗特别具有挑战性的骨不连病例。
