{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:11:42Z","timestamp":1787764302667,"version":"build-2784847793"},"reference-count":49,"publisher":"Elsevier BV","issue":"5","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":365,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedics & Traumatology: Surgery & Research"],"published-print":{"date-parts":[[2022,9]]},"DOI":"10.1016\/j.otsr.2021.102990","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T01:33:15Z","timestamp":1623893595000},"page":"102990","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["Contemporary management of aseptic diaphyseal tibia non-unions \u2013 A systematic review"],"prefix":"10.1016","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2026-3794","authenticated-orcid":false,"given":"Franklin","family":"Fortuin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilize","family":"Burger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0567-3373","authenticated-orcid":false,"given":"Nando","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.otsr.2021.102990_bib0005","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/S0020-1383(07)80003-9","article-title":"Prevalence of long-bone non-unions","volume":"38","author":"Tzioupis","year":"2007","journal-title":"Injury"},{"key":"10.1016\/j.otsr.2021.102990_bib0010","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1097\/00005131-200309000-00002","article-title":"Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor Spatial Frame","volume":"17","author":"Feldman","year":"2003","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.otsr.2021.102990_bib0015","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/1471-2474-14-103","article-title":"Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study","volume":"14","author":"Fong","year":"2013","journal-title":"BMC Musculoskelet Disord"},{"key":"10.1016\/j.otsr.2021.102990_bib0020","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmjopen-2012-002276","article-title":"The relative incidence of fracture non-union in the Scottish population (5.17 million): A 5-year epidemiological study","volume":"3","author":"Mills","year":"2013","journal-title":"BMJ Open"},{"key":"10.1016\/j.otsr.2021.102990_bib0025","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1471-2474-14-42","article-title":"Tibia shaft fractures: Costly burden of nonunions","volume":"14","author":"Antonova","year":"2013","journal-title":"BMC Musculoskelet Disord"},{"key":"10.1016\/j.otsr.2021.102990_bib0030","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/01.blo.0000163836.66906.74","article-title":"Path analysis of factors for delayed healing and nonunion in 416 operatively treated tibial shaft fractures","volume":"438","author":"Audig\u00e9","year":"2005","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.otsr.2021.102990_bib0035","doi-asserted-by":"crossref","first-page":"2979","DOI":"10.1007\/s11999-009-0883-x","article-title":"Do successful surgical results after operative treatment of long-bone nonunions correlate with outcomes?","volume":"467","author":"Egol","year":"2009","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.otsr.2021.102990_bib0040","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.cuor.2007.06.004","article-title":"Factors contributing to non-union of fractures","volume":"21","author":"Perumal","year":"2007","journal-title":"Curr Orthop"},{"key":"10.1016\/j.otsr.2021.102990_bib0045","first-page":"188","article-title":"Functional outcome of tibial nonunion treatment by Ilizarov fixator","volume":"8","author":"Akhtar","year":"2012","journal-title":"Ann Pak Inst Med Sci"},{"key":"10.1016\/j.otsr.2021.102990_bib0050","doi-asserted-by":"crossref","first-page":"485","DOI":"10.2106\/JBJS.J.00342","article-title":"Successful reconstruction for complex malunions and nonunions of the tibia and femur","volume":"93","author":"Buijze","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.otsr.2021.102990_bib0055","doi-asserted-by":"crossref","first-page":"678","DOI":"10.3389\/fphys.2016.00678","article-title":"A concert between biology and biomechanics: The influence of the mechanical environment on bone healing","volume":"7","author":"Glatt","year":"2017","journal-title":"Front Physiol"},{"key":"10.1016\/j.otsr.2021.102990_bib0060","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/00005131-200305000-00006","article-title":"Predictors of reoperation following operative management of fractures of the tibial shaft","volume":"17","author":"Bhandari","year":"2003","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.otsr.2021.102990_bib0065","doi-asserted-by":"crossref","first-page":"51","DOI":"10.17159\/2309-8309\/2016\/v15n1a5","article-title":"The pathogenesis of tibial non-union","volume":"15","author":"Ferreira","year":"2016","journal-title":"SA Orthop J"},{"key":"10.1016\/j.otsr.2021.102990_bib0070","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1302\/0301-620X.84B8.0841093","article-title":"Evolution of the internal fixation of long bone fractures: The scientific basis of biological internal fixation. Choosing a new balance between stability and biology","volume":"84","author":"Perren","year":"2002","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.otsr.2021.102990_bib0075","first-page":"175","article-title":"Physical and biological aspects of fracture healing with special reference to internal fixation","volume":"138","author":"Perren","year":"1979","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.otsr.2021.102990_bib0080","doi-asserted-by":"crossref","first-page":"241","DOI":"10.55095\/achot2008\/044","article-title":"Fracture healing \u2013 The evolution of our understanding","volume":"75","author":"Perren","year":"2008","journal-title":"Acta Chir Orthop Tr"},{"key":"10.1016\/j.otsr.2021.102990_bib0085","first-page":"1003","article-title":"[A case of pseudo-tumoral lymphoid hyperplasia or Castleman's disease]","volume":"108","author":"Baumann","year":"1978","journal-title":"Schweiz Med Wochenschr"},{"key":"10.1016\/j.otsr.2021.102990_bib0090","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/jor.20712","article-title":"Early dynamization by reduced fixation stiffness does not improve fracture healing in a rat femoral osteotomy model","volume":"27","author":"Claes","year":"2009","journal-title":"J Orthop Res"},{"key":"10.1016\/j.otsr.2021.102990_bib0095","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S0021-9290(98)00153-5","article-title":"Magnitudes of local stress and strain along bony surfaces predict the course and type of fracture healing","volume":"32","author":"Claes","year":"2009","journal-title":"J Biomech"},{"key":"10.1016\/j.otsr.2021.102990_bib0100","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jclinepi.2009.06.005","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"62","author":"Moher","year":"2009","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.otsr.2021.102990_bib0105","first-page":"487","article-title":"Rules of evidence and clinical recommendations for the management of patients","volume":"9","author":"Sackett","year":"1993","journal-title":"Can J Cardiol"},{"key":"10.1016\/j.otsr.2021.102990_bib0110","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1302\/0301-620X.98B4.34870","article-title":"Exchange nailing for nonunion of diaphyseal fractures of the tibia: Our results and an analysis of the risk factors for failure","volume":"98","author":"Tsang","year":"2016","journal-title":"Bone Joint J"},{"key":"10.1016\/j.otsr.2021.102990_bib0115","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1097\/BOT.0000000000000311","article-title":"Dynamizations and Exchanges. Success rates and indications","volume":"29","author":"Litrenta","year":"2015","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.otsr.2021.102990_bib0120","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/j.1757-7861.2009.00041.x","article-title":"Treatment of aseptic diaphyseal nonunion of the lower extremities with exchange intramedullary nailing and blocking screws without open bone graft","volume":"1","author":"Gao","year":"2009","journal-title":"Orthop Surg"},{"key":"10.1016\/j.otsr.2021.102990_bib0125","first-page":"283","article-title":"Exchange Nailing for Aseptic Tibial Shaft Nonunion: Emphasis on the Influence of a Concomitant Fibulotomy","volume":"29","author":"Hsiao","year":"2006","journal-title":"Chang Gung Med J"},{"key":"10.1016\/j.otsr.2021.102990_bib0130","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.ocl.2015.09.010","article-title":"Nonunion of the femur and tibia: an update","volume":"47","author":"Bell","year":"2016","journal-title":"Orthop Clin North Am"},{"key":"10.1016\/j.otsr.2021.102990_bib0135","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1302\/0301-620X.77B3.7744925","article-title":"Exchange intramedullary nailing. Its use in aseptic tibial nonunion","volume":"77","author":"Court-Brown","year":"1995","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.otsr.2021.102990_bib0140","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/00003086-198611000-00016","article-title":"The treatment of noninfected pseudarthrosis of the femur and tibia with locked intramedullary nailing","volume":"212","author":"Kempf","year":"1986","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.otsr.2021.102990_bib0145","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1016\/j.injury.2015.03.036","article-title":"Can we achieve bone healing using the diamond concept without bone grafting for recalcitrant tibial nonunions?","volume":"46","author":"Ollivier","year":"2015","journal-title":"Injury"},{"key":"10.1016\/j.otsr.2021.102990_bib0150","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/S0020-1383(10)70014-0","article-title":"Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: A review of 25 cases","volume":"41","author":"Stafford","year":"2010","journal-title":"Injury"},{"key":"10.1016\/j.otsr.2021.102990_bib0155","first-page":"482","article-title":"Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: Review of literature and our experience","volume":"65","author":"Nadkarni","year":"2008","journal-title":"J Trauma"},{"key":"10.1016\/j.otsr.2021.102990_bib0160","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1016\/j.injury.2015.09.040","article-title":"Management of tibial non-unions according to a novel treatment algorithm","volume":"46","author":"Ferreira","year":"2015","journal-title":"Injury"},{"key":"10.1016\/j.otsr.2021.102990_bib0165","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.injury.2008.07.029","article-title":"Treatment of diaphyseal nonunion of the femur and tibia using an expandable nailing system","volume":"40","author":"Steinberg","year":"2009","journal-title":"Injury"},{"key":"10.1016\/j.otsr.2021.102990_bib0170","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.injury.2008.02.024","article-title":"Treatment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft","volume":"39","author":"Oh","year":"2008","journal-title":"Injury"},{"key":"10.1016\/j.otsr.2021.102990_bib0175","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1302\/0301-620X.74B3.1587876","article-title":"Locked Nailing for nonunion of the Tibia","volume":"74","author":"Rosson","year":"1992","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.otsr.2021.102990_bib0180","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/00005131-199406000-00002","article-title":"Nonunion of the tibia treated with a reamed intramedullary nail","volume":"8","author":"Wiss","year":"1994","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.otsr.2021.102990_bib0185","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/00005131-199504000-00007","article-title":"Intramedullary nailing of aseptic tibial nonunions without the use of the fracture table","volume":"9","author":"Moed","year":"1995","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.otsr.2021.102990_bib0190","first-page":"655","article-title":"Early experience and results of bone graft enriched with autologous platelet gel for recalcitrant nonunions of lower extremity","volume":"63","author":"Chiang","year":"2007","journal-title":"J Trauma"},{"key":"10.1016\/j.otsr.2021.102990_bib0195","doi-asserted-by":"crossref","first-page":"3892","DOI":"10.1007\/s11999-014-3640-8","article-title":"Ilizarov Fixator Combined With an Intramedullary Nail for Tibial Nonunions With Bone Loss: Is It Effective?","volume":"472","author":"Gulabi","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.otsr.2021.102990_bib0200","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.otsr.2014.07.005","article-title":"Treatment of nonunion in neglected long bone shaft fractures by osteoperiosteal decortication","volume":"100","author":"Tall","year":"2014","journal-title":"Orthop Traumatol Surg Res"},{"key":"10.1016\/j.otsr.2021.102990_bib0205","first-page":"58","article-title":"Outcome of treatment of nonunion tibial shaft fracture by intramedullary interlocking nail augmentated with autogenous cancellous bone graft","volume":"16","author":"Shah","year":"2014","journal-title":"Nepal Med Coll J"},{"key":"10.1016\/j.otsr.2021.102990_bib0210","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1302\/0301-620X.97B10.35504","article-title":"Hexapod external fixator closed distraction in the management of stiff hypertrophic tibial nonunions","volume":"97","author":"Ferreira","year":"2015","journal-title":"Bone Joint J"},{"key":"10.1016\/j.otsr.2021.102990_bib0215","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jor.2015.10.012","article-title":"Mechanobiology in the management of mobile atrophic and oligotrophic tibial nonunions","volume":"12","author":"Ferreira","year":"2015","journal-title":"J Orthop"},{"key":"10.1016\/j.otsr.2021.102990_bib0220","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1016\/j.injury.2015.09.040","article-title":"Management of tibial non-unions: Prospective evaluation of a comprehensive treatment algorithm","volume":"46","author":"Ferreira","year":"2015","journal-title":"Injury"},{"key":"10.1016\/j.otsr.2021.102990_bib0225","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1097\/BOT.0b013e318172cea5","article-title":"Platelet gel supplementation in long bone nonunions treated by external fixation","volume":"22","author":"Mariconda","year":"2008","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.otsr.2021.102990_bib0230","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.injury.2013.11.019","article-title":"Management of nonunion of lower-extremity long bones using mono-lateral external fixator - Report of 37 cases","volume":"45","author":"Harshwal","year":"2014","journal-title":"Injury"},{"key":"10.1016\/j.otsr.2021.102990_bib0235","doi-asserted-by":"crossref","first-page":"322","DOI":"10.2106\/00004623-200609001-00015","article-title":"Percutaneous Autologous Bone-Marrow Grafting for Nonunions. Surgical technique","volume":"88","author":"Hernigou","year":"2006","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.otsr.2021.102990_bib0240","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1007\/s00264-011-1211-0","article-title":"Fibula-pro-tibia in plating tibial non-unions","volume":"35","author":"Said","year":"2011","journal-title":"Int Orthop"},{"key":"10.1016\/j.otsr.2021.102990_bib0245","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s00264-002-0405-x","article-title":"Functional bracing in the treatment of delayed union and nonunion of the tibia","volume":"27","author":"Sarmiento","year":"2003","journal-title":"Int Orthop"}],"container-title":["Orthopaedics & Traumatology: Surgery & Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1877056821002231?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1877056821002231?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T03:47:28Z","timestamp":1761796048000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1877056821002231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":49,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["S1877056821002231"],"URL":"https:\/\/doi.org\/10.1016\/j.otsr.2021.102990","relation":{},"ISSN":["1877-0568"],"issn-type":[{"value":"1877-0568","type":"print"}],"subject":[],"published":{"date-parts":[[2022,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Contemporary management of aseptic diaphyseal tibia non-unions \u2013 A systematic review","name":"articletitle","label":"Article Title"},{"value":"Orthopaedics & Traumatology: Surgery & Research","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.otsr.2021.102990","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 Elsevier Masson SAS.","name":"copyright","label":"Copyright"}],"article-number":"102990"}}