Tibial pseudarthrosis (7)

Refractory atrophic pseudarthrosis of the distal tibia. The patient, a 40-year-old woman, had already undergone 14 prior operations without achieving consolidation. The pre-operative image revealed atrophic damage.
The treatment comprised focal curettage, stabilisation with a plate and bone graft insertion containing 74 million bone marrow stem cells cultured using the Aastrom Replicell bioreactor at the Barcelona Blood and Tissue bank, biomaterial and autologous plasma clot (post-op).
The patient's progression was satisfactory but partial resorption of the graft was observed after 7 months due to compromised stability.
A new procedure was performed with better focal revascularisation and clear signs of ossification. Further biomaterial was provided and the osteosynthesis plate was replaced with a more angular plate for greater stability. Healing was confirmed at 6 months (yearly x-ray examination).

(The radiographic sequence only shows anterior-posterior views to optimise the on-screen display)