Aim

To evaluate clinical outcomes for patients with osteomyelitis at a major trauma centre limb reconstruction unit.

Percutaneous grafting of non-union using bone marrow concentrates has shown promising results, we present our experience and outcomes following the use of microdrilling and marrowstim in long bone non-unions.

We retrospectively reviewed all patients undergoing a marrowstim procedure for non-union in 2011–12. Casenotes and radiographs were reviewed for all. Details of injury, previous surgery and non-union interventions together with additional procedures performed after marrowstim were recorded for all patients. The time to clinical and radiological union were noted.

We identified 32 patients, in sixteen the tibia was involved in 15 the femur and in one the humerus. Ten of the 32 had undergone intervention for non-union prior to marrowstim including 4 exchange nailings, 2 nail dynamisations, 3 caption graftings, 2 compression in circular frame and 1 revision of internal fixation. Three underwent adjunctive procedures at the time of marroswstim. In 18 further procedures were required following marrowstim. In 4 this involved frame adjustment, 5 underwent exchange nailing, 4 revision internal fixation, 2 additional marrowstim, 2 autologous bone grafting and 3 a course of exogen treatment.

In total 27 achieved radiological and clinical union at a mean of 9.6 months, of these ten achieved union without requiring additional intervention following marrowstim, at a mean of 5.4 months. There were no complications relating to marrowstim harvest or application.

Marrowstim appears to be a safe and relatively cheap addition to the armamentarium for treatment of non-union. However many patients require further procedures in addition to marrowstim to achieve union. Furthermore given the range of procedures this cohort of patients have undergone before and after marrowstim intervention it is difficult to draw conclusions regarding it efficacy.

Tibial non-union causes significant morbidity and functional impairment. Circular frames are valuable tools in the treatment of non-union, however prolonged treatment often causes patients increased morbidity due to pin site problems together with personal and emotional strains.

The purpose of this study was to assess patient centred outcomes following treatment of tibial non-union in circular frame.

We identified 21 patients who had undergone treatment of tibial non-union using a circular frame. Patients were sent questionnaires utilising the Enneking scoring system and EQ-5D general health questionnaire. Fourteen patients responded. There were 3 females, mean age was 48.2 years. The average number of previous operations was 1.2. All patients went on to achieve union with a mean 10.1 months (6–20) in frame.

The mean Enneking score was 58.0% (34.3–77.1). Two patients were enthusiastic about their treatment, two liked it, three were satisfied, four accepted and would do it again while three accepted it but would not do it again.

The Euroqol questionnaire results showed that 8 patients had some difficulty with mobility, 10 had some difficulty with usual activities and 12 moderate pain. There was no significant difference in the EQ VAS score of overall health state for treated patients compared with predicted scores for an age and sex matched UK population (77.7 vs 83.1, p=0.07).

Our study shows that many patients undergoing limb salvage with circular frames for tibial non-union continue to have clinically significant symptoms, however the majority would undergo similar treatment again and we found no difference in overall health state compared with age and sex matched predicted scores. Circular frames are undoubtedly a valuable tool in the management of non-union however patients should be given realistic counselling regarding the treatment and expected outcome.