Management of tibial non-unions: Prospective evaluation of a comprehensive treatment algorithm

Abstract

Tibial non-unions represent a spectrum of conditions and are challenging to treat. The optimal management remains unclear despite the frequency with which these diagnoses are encountered. We developed a tibial nonunion treatment algorithm following two retrospective audits of our patient outcomes and evaluated this algorithm in this prospective series. Thirty-seven consecutive patients with 39 uninfected tibial non-unions were treated according to our proposed treatment algorithm. There were 30 men and seven women with a mean age of 34 years. Twenty-three non-unions were classified as stiff hypertrophic, ten mobile atrophic and four mobile oligotrophic. Two non-unions were classified as type B1 defect non-unions. Bony union was achieved after the initial treatment in 37/39 (94.8%) tibias. Two patients had failure of treatment. These patients presented with progressive deformity after the external fixator was removed. One of these patients was successfully retreated according to the tibial non-union treatment algorithm. This resulted in final bony union after treatment in 38/39 (97.4%) tibias. Our proposed treatment algorithm appears to produce high union rates across a diverse group of tibial non-unions. These conditions however, remain difficult to treat and should be referred to specialist units where advanced reconstructive techniques are practised on a regular basis.