Tibial Non-Union

Tibial Non-Union

using Grafton® DBM Putty and Morselized Allograft

Overview

Dr. Lindsey used Grafton DBM Putty and cancellous chips. The following are Dr. Lindsey's guidelines for use.

Patient Background

The patient is a 36-year-old male who sustained a Grade 2 comminuted open tibial fracture approximately nine months before the grafting procedure. The fracture occurred at the junction between the metaphysis and diaphysis. There was some healing on the metaphyseal side, but required a graft at the metaphyseal/diaphyseal junction.

Procedure

• Follow all guidelines listed on product inserts.
• The allograft bone tissue (cancellous chips) is removed from original package using standard aseptic conditions and placed in the plastic tray.
• The allograft cancellous bone chips are soaked in the sterile saline solution and left completely immersed for 20-30 minutes prior to usage.
• The amount and size of allograft necessary for the orthopedic procedure are based upon the size and type of the bone defect.
• The container with Grafton DBM Putty is then opened under sterile conditions.
• The cancellous bone chips are morselized into smaller chips.
• The Grafton DBM Putty is added to the plastic tray containing allograft bone. chips within the ratio 3 - 4 volume units of allograft and 1 unit of Grafton DBM Putty.
• The Grafton DBM Putty and allograft bone chips are mixed together for a couple of minutes until the homogenous mixture is reached.
• In the meantime, the bed for the allograft is prepared by meticulously cleansing, (i.e., debridement of any nonviable tissues in a case of infection or open trauma, removal of fibrous tissue in a case of non-union), followed by pulsatile irrigation.
• The bone defect is then packed tightly with the allograft-Grafton DBM mixture.
• Following proper bone grafting techniques, no irrigation can be performed after the graft has been placed.