{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:44:44Z","timestamp":1787755484509,"version":"build-2784847793"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2018,6,13]],"date-time":"2018-06-13T00:00:00Z","timestamp":1528848000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS OA"],"published-print":{"date-parts":[[2018,6,28]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Nonunion of long-bone fractures is difficult to treat, especially when the bones are osteoporotic or there is a large bone gap as a result of repeated failure of the metallic nails or implants. In such cases, the use of an autologous intramedullary fibular strut graft may be a viable treatment option.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Twenty-two patients with a complex nonunion of the shaft of the femur, humerus, or tibia were managed with a free autologous fibular strut graft for intramedullary fixation with use of closed or open methods. All patients had evidence of moderate to severe local osteoporosis and had a bone gap ranging from 4 to 20 mm. Nineteen patients had had 1 to 4 prior operations. The mean age was 51.5 years. The duration of nonunion ranged from 9 months to 4 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The mean time to union was 17 weeks (range, 8 to 26 weeks), and the mean duration of follow-up was 4 years (range, 6 months to 17 years). All but 2 patients had healing at the time of the latest follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The identification of a viable option for the treatment of difficult nonunion in osteoporotic bones has been a challenge. The insertion of a free autologous intramedullary fibular strut graft provided mechanical stability, and osteogenesis occurred inside the medullary canal of the host bone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.17.00050","type":"journal-article","created":{"date-parts":[[2018,6,13]],"date-time":"2018-06-13T14:53:41Z","timestamp":1528901621000},"page":"e0050","source":"Crossref","is-referenced-by-count":16,"title":["The Use of a Free Fibular Strut as a \u201cBiological Intramedullary Nail\u201d for the Treatment of Complex Nonunion of Long Bones"],"prefix":"10.2106","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5690-4285","authenticated-orcid":false,"given":"Surender Singh","family":"Yadav","sequence":"first","affiliation":[{"name":"Mirpur Institute of Medical Sciences, Rewari, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,6,28]]},"reference":[{"issue":"204","key":"R1-20230714","first-page":"162","article-title":"Nonunion of the humerus: rigid fixation, bone grafting, and adjunctive bone cement","author":"Trotter","year":"1986","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"R2-20230714","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/S0030-5898(20)31514-5","article-title":"The treatment of nonunions and pseudarthroses of the humeral shaft","volume":"21","author":"Rosen","year":"1990","journal-title":"Orthop Clin North Am."},{"issue":"5","key":"R3-20230714","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1302\/0301-620X.75B5.8376445","article-title":"Reconstruction of the humerus with an intramedullary fibular graft. 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Treatment with a medial approach, an anterior plate, and a vascularized fibular graft","volume":"72","author":"Jupiter","year":"1990","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"R7-20230714","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ocl.2009.07.008","article-title":"Viable bone and circulatory factors required for survival of bone grafts [table of contents.]","volume":"41","author":"Cannada","year":"2010","journal-title":"Orthop Clin North Am."},{"issue":"1","key":"R8-20230714","doi-asserted-by":"crossref","first-page":"28","DOI":"10.13107\/ti.2016.v02i01.017","article-title":"Non-union distal femur fracture: causes and management options","volume":"2","author":"Maheshwari","year":"2016","journal-title":"Trauma Int"},{"issue":"5","key":"R9-20230714","doi-asserted-by":"crossref","first-page":"655","DOI":"10.2106\/00004623-197557050-00013","article-title":"Use of polymethylmethacrylate to enhance screw fixation in bone","volume":"57","author":"Cameron","year":"1975","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"R11-20230714","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S1008-1275(08)60068-1","article-title":"LiXK. 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