Accordion technique used in treatment of hypertrophic nonunion

Abstract

Objective To evaluate the therapeutic effects of the accordion technique used in external fixation for long bone hypertrophic nonunion. Methods From August 2013 to December 2015, 13 patients with hypertrophic nonunion were treated by the accordion technique (distraction, compression and re-distraction) used together with an Ilizarov ring external fixator or a monolateral external fixator. They were 10 males and 3 females with an average age of 44.6 years (from 18 to 63 years). The nonunion occurred in the middle femur in 5 patients, in the femoral supracondyle in one, in the tibial diaphysis in 4, and in the distal tibia in 3. The procedure was performed with a preassembled external fixator without open surgery or bone graft. The pathological sites were gradually distracted (0.25 mm/day) from the seventh day postoperatively. In case of deformity, correction was conducted to restore the alignment. At the same rate of distraction, compression was started after the equal length was achieved and next followed by distraction. The frequency of cycle depended upon the callus observed in the X-rays. Results The mean follow-up for the 13 patients was 19 months (from 10 to 38 months) after removal of the external fixator. All the cases of hypertrophic nonunion obtained bony union after a mean duration of 7.5 months (from 5 to 13 months). No nonunion or deformity recurred during the follow-up. The complications such as pin-site infection (in 4 cases) and mild Achilles's tendon contracture (in 2 cases) were prevented or treated by careful nursing and rehabilitation. Conclusion The accordion technique together with an external fixator is a reliable and effective treatment for hypertrophic nonunion. Key words: External fixators; Bone regeneration; Fractures, ununited; Accordion technique