GeneralG18NonunionswithDefects幻灯片.pptVIP

* AT 2 years post-injury, revision fixation was performed proximally, along with cancellous grafting, using a blade plate for better fixation into the head. * At 3 years post-injury, consolidation between the graft and the humeral head had occurred, and the arm was pain-free. Due to a malunion into varus, her abduction was limited to about 50-60 degrees, but she was able to get her hand to her face and the back of her head, and it was very helpful in activities of daily living. * This case shows a 10 year follow-up of a free fibula graft done for segmental bone loss in the femur following a motorcycle accident. The woman is fully weightbearing without any aid to ambulation and works as an over the road truck driver. * Distraction osteogenesis was discovered in the late 1940’s and early 1950’s in Russia by Ilizarov. This was an entirely new aspect of the biological behavior of bone. He discovered that new bone formation could be induced by very slowly pulling apart two well vascularized bone segments using external fixation. This process involves local neovascularization and increased biosynthetic activity. Osteoprogenitor cells are recruited and activated from local mesenchymal sources. It results in intramembranous bone formation in the gap between the segments. * The Ilizarov technique begins with application of an external fixator. The classic fixator used tensioned wires through the bone segments connected to rings around the limb, which are then connected to each other with threaded rods. Half pin monolateral fixators can be used in similar fashion for many applications of the technique. The bone is cut with a percutaneous corticotomy, usually in the metaphysis, preserving as much as possible of the intramedullary and periosteal blood supply. After corticotomy, there is a latency period of 5 -14 days before distraction is begun. Once the distraction process is started, the cut bone surfaces are slowly pulled apart at a rate of about .25 mm every 6 hour