Abstract
Introduction: The purpose of this investigation was to evaluate the outcomes following reamer-irrigator-aspirator (RIA) autogenous bone grafting (ABG) of high-grade open tibia fracture nonunions stabilized via multiplanar external fixation. Methods: We retrospectively reviewed all patients with Gustilo-Anderson type III open tibia fractures treated with multiplanar external fixation and who underwent RIA ABG for nonunion at our institutional Level 1 Trauma Center between 2008 and 2015. All patients between 15 and 65 years of age with a minimum of six-month follow-up were included. The primary outcomes of interest were achievement of union, time to union, and incidence of revision surgery. Complications and all-cause reoperation were recorded as secondary endpoints. Results: Fifteen patients met the inclusion criteria with a mean age of 41.1 ± 14.0 years. RIA ABG was harvested from the femur in all cases, with a mean volume of 34 ± 15 mL. At an average follow-up of 13.3 ± 6.8 months, all patients achieved union, including two who required repeat RIA ABG. One patient experienced a femoral shaft fracture four months following RIA that required intramedullary fixation. The average time to union was 6.0 ± 6.3 months. Twelve patients (80%) went on to union within six months and 13 (86.7%) within one year. Five patients experienced a total of six post-operative complications including three deep infections, one refracture through the nonunion site, and one gradual varus deformity. Two patients in this series required a subsequent RIA autografting procedure secondary to persistent nonunion despite initial RIA. Conclusion: We found that RIA ABG offered a reliable solution to nonunion of Gustilo-Anderson type III open tibial fractures treated with multiplanar external fixation, circumventing the need to change the method of fixation.
Highlights
IntroductionTibial nonunion following severe open tibial fractures (modified Gustilo-Anderson classification type III) poses a difficult problem
Tibial nonunion following severe open tibial fractures poses a difficult problem
This study presents a consecutive series of open GustiloAnderson type III tibial fractures that developed nonunion and were treated with RIA Autogenous bone grafting (ABG) for nonunion following treatment with multiplanar external fixation
Summary
Tibial nonunion following severe open tibial fractures (modified Gustilo-Anderson classification type III) poses a difficult problem. Definitive treatment with multiplanar external fixation offers a more versatile platform to manage these injuries, as opposed to monoplanar external fixation or internal fixation, permitting deformity correction and compression of the fracture [1]. These are very complex injuries and frequently develop nonunion related to the significant energy imparted during the trauma with resulting disturbance of the local blood supply, poor soft tissue envelope, and potential bone loss [2, 3]. Autogenous bone grafting (ABG) in conjunction with circular fixation may provide an alternative management strategy for nonunion. There are a limited number of series exploring the success of RIA for nonunion following circular fixator application for open tibial fractures [1, 10]
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