Use of Solid and Cancellous Autologous Bone Graft for Fractures and Nonunions  James T. Marino, MD, Bruce H. Ziran, MD  Orthopedic Clinics  Volume 41, Issue 1, Pages 15-26 (January 2010) DOI: 10.1016/j.ocl.2009.08.003 Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 1 Judet method of osteoperiosteal elevation to create a pocket to place local bone graft. Orthopedic Clinics 2010 41, 15-26DOI: (10.1016/j.ocl.2009.08.003) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 2 Phemister method of scaling the cortex to expose the onlay graft to the microvasculature of the bone. Orthopedic Clinics 2010 41, 15-26DOI: (10.1016/j.ocl.2009.08.003) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 3 (A) Anatomic planes used for posterolateral bone grafting. The interval follows the posterior fibula across the interosseous membrane to the tibia. This exposure becomes more difficult in the proximal aspects of the tibia. (B) Illustration showing the position of the patient for posterolateral bone grafting, along with the preparation to harvest autograft from the posterior iliac crest. (C) Intraoperative image of the exposure along with adjunct fixation. In some cases, the fibula was used as a laterally based strut to help support the tibia. Because of the fixed angles of the bicortical screws in the fibula, they functioned similarly to the current locked plating technology. (D) Intraoperative image of the graft material covering and spanning both tibia and fibula. (E) Radiograph of a posterolateral graft at 8 months after it has healed and incorporated. Note that anterior defects may be well tolerated if an adequate posterior consolidation is achieved. Orthopedic Clinics 2010 41, 15-26DOI: (10.1016/j.ocl.2009.08.003) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 4 The appearance of different nonunions. Attempted bone formation about the fracture site is an attempt to stabilize the site and shows biologic capacity. Lack of any bone formation suggests the lack of vascularity and biologic potential. Orthopedic Clinics 2010 41, 15-26DOI: (10.1016/j.ocl.2009.08.003) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 5 (A) CT scan of a patient who presented after colonic herniation through the iliac wing after an aggressive bone graft procedure. (B) Intraoperative photo of the patient showing colonic viscera through the iliac wing. (C) Radiograph showing the reconstruction with retention screen and reconstruction plate. Orthopedic Clinics 2010 41, 15-26DOI: (10.1016/j.ocl.2009.08.003) Copyright © 2010 Elsevier Inc. Terms and Conditions