Abstract
PurposeLower leg nonunion in pediatric patients is a rarity. Therefore, eight European pediatric trauma units retrospectively analyzed all patients younger than 18 years suffering lower leg fractures resulting in aseptic nonunion.MethodsThirteen children and adolescents less than 18 years old (2 girls and 11 boys) diagnosed with aseptic nonunion of the tibia and/or fibula were evaluated. In all patients, epidemiological data, mechanism of injury, fracture configuration, and the initial treatment concept were assessed, and the entire medical case documentation was observed. Furthermore, potential causes of nonunion development were evaluated.ResultsThe mean age of patients was 12.3 years with the youngest patient being seven and the oldest being 17 years old. Open fractures were found in six out of thirteen patients (46%). Nonunion was hypertrophic in ten and oligotrophic in three patients. Mean range of time to nonunion occurrence was 7.3 ± 4.6 months. Nonunion healing resulting in complete metal removal was found in 12 out of 13 patients (92%), only in one case of a misinterpreted CPT type II osseous consolidation could not be found during the observation period. Mean range of time between surgical nonunion revision and osseous healing was 7.3 months as well.ConclusionIf treatment principles of the growing skeleton are followed consistently, aseptic nonunion of the lower leg remains a rare complication in children and adolescents. Factors influencing the risk of fracture nonunion development include patient’s age, extended soft tissue damage, relevant bone loss, and inadequate initial treatment.
Highlights
Fracture nonunion is difficult to treat and represents a chal‐ lenge for the treating surgeon as well as it is a physical and psychological burden for the young patient
It may be assumed that a certain number of unreported cases exist and that the rate of lower leg fracture nonunion in children and adolescents is higher than described in the literature
Definitive sur‐ gical revision included locking compression plating (LCP) combined with autologous cancellous bone grafting in six patients (Fig. 1a–d), reamed tibial exchange nailing in three patients, elastic stable intramedullary nailing in one patient (Fig. 2a–e) and external fixation methods in two patients (Fig. 3a–f) [27, 28]
Summary
Fracture nonunion is difficult to treat and represents a chal‐ lenge for the treating surgeon as well as it is a physical and psychological burden for the young patient. The organization of the fracture hematoma and preparation phases and especially the cellular organiza‐ tion phase play an important role [8] In pediatric fractures, these biological factors compete and complete each other in fracture healing, so that overall development of nonunion is very rare [9, 10]. Sporadic lower leg fracture nonunion is reported in individual case series in adolescents with adultlike physique following various different surgical treatment concepts [12,13,14,15,16,17]. Most of these cases involve adolescents over 10 years of age [18]. It may be assumed that a certain number of unreported cases exist and that the rate of lower leg fracture nonunion in children and adolescents is higher than described in the literature
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