Abstract
background : Aseptic tibial non union after initial locked intramedullary nail fixation is not common. There are many techniques that deal with this complication. Which is the best method is controversial. An algorithm is suggested to help choice of the most suitable technique for each case. MaterialS and Methods : In the period from august 2010 to august 2014, 29 cases of aseptic tibial non union after locked intramedullary nail fixation were treated according to a suggested algorithm based on the location of non union, percent of bone contact and nail diameter relative to the diameter of the medullary canal. The mean follow up period was 14 months. Sepsis was excluded before active management of any case. Results : All cases had united but with variable time differed according to the method of treatment and the underlying pathology. The complications were few and related mainly to cases treated with the augmentation plate. CONCLUSION : Successful treatment of aseptic tibial non union after locked intramedullary nail fixation depends on proper identification of the exact etiology of the non union whether it was a stability problem or a biological problem or both conditions.
Highlights
Aseptic non union after initial locked intramedullary nail is not common in orthopaedic practice[1]
The question usually aroused in this condition, which is the best method to choose? In this study an algorithm based on the location of non union and the underlying pathology that predisposes to this complication was used
For the second group of patients (Diaphyseal non union), 10 cases with ill fitted nails were treated with nail removal and exchange with the largest possible reamed nail diameter can be fitted in the medullary canal, these cases had comminution less than 50% of the circumference so no bone graft was used (Figure 3)
Summary
Aseptic non union after initial locked intramedullary nail is not common in orthopaedic practice[1]. The current algorithm identifies the underlying pathology contributing to aseptic non union in cases initially fixed with locked intramedullary nail and finds out the suitable surgical technique for each case It addresses stability problems as the presence of non union in unstable location[Metaphyseal /Diaphyseal area) where the medulla has no uniform diameter, initial fracture fixation with ill fitted nail in the diaphysis or presence of marked comminution impairing fracture stability. For the second group of patients (Diaphyseal non union), 10 cases with ill fitted nails were treated with nail removal and exchange with the largest possible reamed nail diameter can be fitted in the medullary canal, these cases had comminution less than 50% of the circumference so no bone graft was used (Figure 3). Augmentation plating and bone graft was done for two cases in which non union was associated with bone comminution making a defect more than 50% of circumference (Figure 4)
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