In more complex non-unions, there are often specific conditions that complicate classification and treatment. These situations are characterized by poor clinical condition of the patient associated with low bone tissue and soft tissue quality.

Often there is a severe loss of bone substance that must be restored. Traditional treatments, such as bone transport with external fixation, can be performed or biotechnologies can be used in polytherapy, avoiding autologous bone extractions or increasing its effectiveness.

FIG. 5

Severe proximal tibia non-union with loss of bone substance.

In a previous surgery, the entire pathological tissue was removed.

Reconstruction was performed through the bone transport method with Ilizarov type circular external fixation.

In a second surgery, the application of growth factors enabled the definitive consolidation of the tibia, bringing the docking point to fusion.

FIG. 6

Severe non-union of the proximal femur with bone loss in the trochanteric region replaced during previous operations with cement.

The reconstruction was performed through the removal of the previous synthesis methods, complete removal of the cement and necrotic tissue and the application of bone grafts, growth factors and mesenchymal stromal cells.

The deformity was corrected and stability restored using blade plate.

The positive evolution led to the patient healing with good residual joint function.