Can Custom Bone Pegs Facilitate Effective Treatment Of Nonunions?

By Devon Glazer, DPM

Nonunions can be difficult to address with any patient. Accordingly, the surgeon may benefit from any additional modalities that can prevent a recurrent nonunion after a revision. When evaluating a nonunion for surgical revision, one should critically evaluate the primary fixation. If a fixation technique has failed with the use of screws and both sides of the failed fusion have been penetrated, bone pegs can be a consideration for a secondary form of fixation.    The revised fusion will need primary fixation. My personal choice is to place the new fixation in a different manner than the one that had originally failed. When the surgeon removes the original screw fixation, there is a deficit. However, surgeons can use that deficit to their advantage as a lattice for bone growth. By placing a corticocancellous graft peg across the deficit site, the surgeon can achieve a secondary form of fixation with the benefits of rigidity and incorporation that corticocancellous grafts possess. The combination of pegs in conjunction with primary standard fixation will obviously increase stability. The increase of stability can only assist the surgeon in completing the goal of fusion.    The use of corticocancellous bone pegs has shown fusion rates of 90 percent in the hand.1 Commercial pegs may not be available and without a strong cortical wall, they could fail in the application process. The fabrication of a custom graft from a tricortical bone graft intraoperatively can actually be quite easy and completed in an efficient manner.

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