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Bone recalcitrant nonunion or pseudoarthrosis

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Periosteum transfer of vascularized fibula

Absence of binding or repair of a fracture or bone fragment is called non-union or pseudoarthrosis. Although it may occur, it is quite rare in pediatric fractures. However, it is common when we use structural bone allografts (See Figure 3).

The vascularized fibular periosteum has a great ability to form bone and to accelerate bone union. It is therefore a "miraculous" technique in the treatment of congenital pseudoarthrosis of the tibia and recalcitrant non-union in general (Figure 8 AB)


Figure 8A. CT of a tibia. After the use of a massive allograft to treat a tibial Ewing's sarcoma, allograft has did not successfully integrate into the bone. We use a periosteum graft of vascularized fibula to stimulate bone union.


Figure 8B. 3D CT of a tibia. In a short time we managed to unite the pseudoarthrosis. The "miracle" is due to the existence of stem cells in the inner layer of the periosteum, which have great ability to revascularize and to form bone.

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