Treatment of infection and non-union after bilateral complicated proximal tibial fracture

Background and Aims: Complicated tibial fractures form a great challenge fo r orthopaedic surgeons. Non-unions and infections are more common in compli cated than in closed fractures. In the present study, we describe a patient case treated for non-union combined to chronic osteomyelitis after bilater al open proximal tibial fractures. Material and Methods: A female patient born in 1946 was muIti-traumatised, when a car hit her as a pedestrian. She went through multiple operations of both tibias due to bilateral complicated proximal fractures. Fractures wer e stabilised at first with internal fixation, which had to be changed to ex ternal fixation due to infection of both sides. During the last operative s tep a commercial bone graft based on hydroxyapatite and bovine type I fibri llar collagen/tricalcium phosphate ceramic (Collagraft(C)) mixed with autog enous bone marrow was applied. Results: Fractures united after 28 (right tibia) and 22 (left tibia) months of follow-up. At the final follow-up visit 55 months after the initial acc ident patient walked without any aid and showed no signs of an infection. Conclusions: The use of commercial mixed xeno-/autogenous-bone graft may pr ovide a feasible alternative in complicated chronic non-unions of the tibia even when an infection is present, especially when autogenous bone is not easily available after previous attempts of bone grafting.