Drilling percutaneously through the nonunion site: a more cost effective solution for long bone nonunions

Abstract

Abstract Background: Despite the development of improved fracture treatment, bone nonunion remains a challenge for orthopedic surgeons. Various therapies have been examined for the treatment of nonunions, including fixator exchange, bone grafting, application of growth factors, and even cell and gene therapy. However, all these methods have limitations, such as donor site complications, soft tissue problems, high cost and long hospitalization. This study aims to find a minimally invasive and cost-effective method for nonunion treatment. Methods: Between October 2018 and October 2019, nineteen patients with long bone nonunions (11 tibia and 8 femur) were treated in our trauma center. There were 14 males and 5 females and the average age was 56.1 years. Treatment of the nonunion was performed by a novel technique consisting of a direct drilling procedure. Under C-arm guidance, a k-wire was used to percutaneously drill across the nonunion site. The k-wire was directed along the longitudinal axis of the bone. The necrotic cortex of the nonunion site was drilled and the medullary cavity was re-established. The implants were maintained, as the fixation was stable. Regular rehabilitation and follow-up was performed until the patient achieved bone union. Results: 18 of the 19 cases achieved succesful bony union with this technique. Sixteen achieved union after a single drilling procedure, while two patients required a second drilling procedure to achieve union. One failure occurred in a female patients with a tibial shaft nonunion which only achieved union after revision fixation and cancellous bone grafting. The average union time after drilling technique was 7.4 month (range: 4-14), and the average hospital stay was 5.3 days (range: 4-15). Conclusion: This drilling technique provides a novel, minimally invasive, effective and low-cost method for the treatment of bone nonunion. It minimizes the iatrogenic damage and preserves the biological environment for fracture healing. The encouraging results of this technique warrants a larger study. Trial registration: Chinese Clinical Trial Registry ChiCTR-PPC-14005360. Registered 17 October 2014