Treatment of nonunion after surgery for open tibial fracture of Gustilo type III through the tibial posterior approach

Abstract

Objective To investigate the clinical efficacy of treatment of nonunion after surgery for open tibial fracture of Gustilo type Ⅲ through the tibial posterior approach.Methods We retrospectively analyzed the 16 patients who had suffered from nonunion after surgery for open tibial fracture from June 2010 to June 2013.They were 6 females and 10 males,aged from 19 to 64 years (average,43.8 years).All their initial fractures were of Gustilo type Ⅲ,affecting the middle and lower segments of the tibia.They received primary external fixation and their anterior soft tissue conditions were poor after operation.By Weber-Cech classification,there were 3 cases of hypertrophic nonunion and 13 ones of atrophic nonunion.The time from initial injury to operation ranged from 9 to 12 months (average,9.8 months).They all received open reduction and bone graft and internal fixation through the tibial posterior approach.Results The operation time for this group averaged 1.8 hours (from 1.5 to 2.5 hours).The intraoperative blood loss averaged 300 mL (from 200 to 600 mL).The wounds were primarily healed in all but one case who had exposure of heel tendon due to superficial wound infection.The 16 patients were followed up for 8 to 36 months (average,24 months).All of them obtained bony union after a mean time of 8.8 months (from 6 to 12 months).By the Johner-Wruhs criteria,functional recovery of the lower limb joint was rated at the last follow-up as excellent in 10 cases,good in 3,fair in 2,and poor in one.Conclusions Open reduction and bone graft and internal fixation through the tibial posterior approach is an effective treatment of nonunion after surgery for open tibial fractures of Gustilo type Ⅲ because the poor anterior tissue conditions do not allow the tibial anterior approach.The keys to satisfactory clinical effect are strict compliance with operative indications,familiarity with surgical approach and aseptic operation. Key words: Tibial fractures; Fractures, open; Fractures, ununited; Tibial posterior approach