Autologous Transplantation of Press-fit Bone Cylinders in the Treatment of Pelvic Nonunion.

The present study describes method for autologous bone transplantation to an area of nonunion at the pelvic ring in a way that ensures the best possible bone-to-bone interface ("press-fit") and provides optimal preconditions for the ingrowth of the bone graft. We modified a technique that has been used to transplant press-fit bone-baseplate-cartilage cylinders for the repair of joint cartilage defects. The technique allows for precise harvesting of bone cylinders with a diamond-coated and fluid-cooled instrument. At the site where the graft shall be inserted, a cylindrical hole is created with a corresponding hollow diamond-coated trephine. This ensures an optimal press-fit implantation of the graft. The new surgical technique has been applied in four patients with nonunion of the pelvic ring. No intraoperative or postoperative complications occurred. In three patients, the procedure led to a reduction of pain and a higher level of mobility as well as a timely radiographic union (imaging not available for another patient). Our technique offers a valuable new treatment option for pelvic nonunion. The current article serves as a proof of concept. Future comparative studies will have to determine its value in detail.