External skeletal fixation technology to treat refractory nonunion in long bones following prior internal fixation

Abstract

Objective To observe clinical outcomes of external skeletal fixation technology without bone graft in treatment of complex bone nonunion and defect following prior internal fixation. Methods From April, 2002 to December, 2008 in our hospital, a total of 17 patients with complex bone nonunion and bone defect were treated with external skeletal fixation withont bone graft. They were 12 men and 5 women,aged 11 to 50 years (average, 34. 7 years). The nonunion involved tibia in 10, femur in 5 and humerus in 2 cases. The duration for nonunion ranged from 8 to 21 months (average, 16.3 months). Bone defects ranged from 2. 5 to 11.0 cm (average, 3.5 cm) . End-to-end compression followed by lengthening and segmental bone transport by lengthening were conducted for the management. Twelve cases complicated with bone defect or limb shortening received epiphysiotomy to restore the limb length in the period of compressive fixation. The patients were followed regularly to assess their healing of nonunion and defects. Results According to clinical follow-up, all patients obtained fracture healing after a mean time of 5. 2 months (range, 3 to 21 months). The 12 patients with bone defects sustained a mean bone lengthening of 4. 8 cm, obtaining a balance in limb length. Their healing time ranged from 4 to 11 months (average, 5.2 months). Their mean bone union index was 32 d/cm.Conclusions The plastic external skeletal fixation can promote bone healing. Bone lengthening through epiphysiotomy can restore the balance in limb length without bone graft. Therefore, this tecnology is an effective treatment for complex bone nonunion and defect in long bones. Key words: External fixators; Fractures, ununited; Treatment outcome