Tibial Nonunion Research Articles

Outcome of Bone Transport Using Ilizarov External Fixator in Infected Non-Union of Tibia with Large Bone Defects: Comparison of Those with 5–10 cm Bone Defect with Those Having ≥ 11 cm Bone Defect

Outcome of Bone Transport Using Ilizarov External Fixator in Infected Non-Union of Tibia with Large Bone Defects: Comparison of Those with 5–10 cm Bone Defect with Those Having ≥ 11 cm Bone Defect

Special Considerations in the Orthopaedic Trauma Patient: Curbing Negative Social Behaviors

Optimizing the orthopaedic trauma patient for surgical intervention presents unique challenges. Due to the acute nature of musculoskeletal injuries and time constraints for treatment, there is a limited window for overall patient comorbidity optimization prior to surgical fracture repair. Certain social behaviors including tobacco use, excessive alcohol consumption, and inappropriate opioid medication usage can have a negative impact on wound and fracture healing. Curbing such negative social behaviors can have a positive outcome on patients who are affected by musculoskeletal trauma. Addressing these challenging issues, via available resources, can have a significant impact on recovery after sustaining orthopaedic trauma. A tactical approach focused on relationship building with patients and their families as well as highlighting strategies to curb negative social behaviors is presented involving a patient with an infected tibial nonunion.

WHAT IS THE IMPACT OF HIP DISLOCATION ON PATIENT QUALITY OF LIFE AFTER TOTAL HIP ARTHROPLASTY? HOW DO SPECIFIC IMPLANTS (LARGE HEADS, DUAL MOBILITY, OR CONSTRAINED LINERS) DEAL WITH THIS PROBLEM?

Dislocations have impact on quality of life, but it is difficult to quantify this impact for each patient. The Quality-of-Life Time Trade-Off assesses the percentage of a patient's remaining life that the patient would be willing to trade for perfect health [1]. This technique has been used for non-unions [2], but never proposed for dislocation.154 patients (with 3 recurrent dislocations) undergoing revision were asked to choose between living with their associated dislocation risk or trading a portion of their life expectancy for a period of perfect health without dislocation, thus determining their Quality-of-Life score. This score may range from 0.1 (willing to trade nine years among 10) to 1.0 (unwilling to trade any years). Additionally, patients were assessed on their willingness to trade implant survival time for a reduced risk of dislocation, considering various implant options that might offer lower (but not necessary) survival time before revision than the theoretical best (for the surgeon) “standard” implant, thus determining a “Survival Implant Quality” score.Patients diagnosed with 3 hip dislocations have a low health-related quality of life. The score of our “dislocation” cohort was average 0.77 with patients willing to trade average 23% of remaining lifespan for perfect health (range 48% to 12%). This score is below that (0.88) of illnesses type-I diabetes mellitus [3] and just higher than tibial non-union (0.68) score [2]. The mean “Survival Implant Quality” score of our recurrent dislocation cohort was 0.71 (range 0.59 to 0.78) which means that patients accept to trade average 3 years (range 2 to 4 years) among 10 theoretical years of survival of the implant.Hip dislocation has a devastating impact that can be quantified for each patient when discussing revision and choice of implants for instability.For references, please contact the author directly.

Treatment of Diaphyseal Tibial Non-unions After Open Fracture: A Retrospective Observational Study on Characteristics and Outcomes

Abstract Purpose Non-union is a significant complication following open diaphyseal tibia fractures. Management can be complex and unpredictable. Several principles must be addressed often in combination to achieve union. The aim of this study is to report on the characteristics, management and eventual outcome of non-united open tibial fractures over a 12-year period from a level I trauma centre. Methods This is a retrospective observational study of all adults (age 18 years and older) presenting to a level 1 trauma centre with a diaphyseal tibia fracture. Non-union was diagnosed using the standard FDA definition of incomplete union by 9 months or no progress to union in the preceding 3 months. Injury and patient demographics in addition to all interventions and complications were recorded for each patient. Results Forty three cases of diaphyseal non-union were identified from 2008 to 2019. Only the presence of peripheral vascular disease demonstrated a statistically significant association with the development of non-union. In 44% of cases, more than one additional operation was required to achieve union. Successful union was achieved in 90% of cases with 74% of patients returning to full pre-injury function without complication. Conclusion Management of non-union is a complex problem which requires a multifaceted and bespoke approach. We have included an algorithm to help guide decision making based on our institutional experience. A satisfactory result is achievable in the majority of patients.

Dead or alive — use of indocyanine green angiography for intraoperative assessment of bone vitality in nonunion fractures: a controlled case series of four patients

Background. Indocyanine green (ICG) fluorescence imaging is a surgical tool with increasing applications in various surgical disciplines. During nonunion resection, the assessment of bone vascularization is currently based only on the surgeon’s experience. We introduced the use of indocyanine green (ICG) angiography in orthopedics. The aims of the study: 1) to use ICG fluorescence angiography to evaluate the bone perfusion in patients with atrophic nonunion, where poor or absent ICG flow reveals avascular tissue associated with bone necrosis requiring surgical resections; 2) to describe our case series of patients operated with this technique. Methods. We used ICG angiography in patients operated for tibial nonunion resection. We administered 0.5 mg/kg of ICG powder dissolved in sterile saline at 2.5 mg/ml concentration. The time from the injection to the beginning of appreciation of the green dye was measured. Non-viable bone was resected accordingly. Patient underwent routine follow-up. We enrolled all the suitable patients operated from April 2019 to June 2021 and matched three control patients for each of them. We reviewed their medical records and noted any relevant data. Results. We enrolled 4 cases and 12 controls, all male. The mean age was 30.8±6.9 years. The mean duration from trauma to surgery was 10.5 (0.7-25.0) months. The mean duration of surgery was 190.8±40.3 min. The defect size was 4.89±2.03 cm. ICG allowed rapid visualization of bone vascularization after 25-45 sec. No adverse events were observed. The mean external fixation time was 11.8±5.0 months. The mean external fixation index was 2.69±1.10. Seven patients needed a surgical revision during treatment. Three patients underwent reintervention after frame removal. There are no statistically significant differences between cases and controls. Conclusions. The research findings of this study are limited by the small number of observations. However, this technique is safe, easy, and rapid and may contribute to intraoperative decision of how much to resect. Using ICG could objectively demonstrate bone perfusion to help surgeons to avoid massive bone defects.

Reconstruction of gap non-union tibia with composite use of extramedullary fixation and bone transport by monorail fixator: a prospective case series.

Non-union is a complex, multifactorial orthopaedic problem that requires multiple treatment modalities for its management. It can result from infection, segmental bone loss, soft-tissue loss, and associated host factors. External fixators as management of gap non-union are bulky and give rise to a number of complications In our study, we have described a technique where we have used extramedullary fixation in the form of a tibial locking plate and transportation of part of the tibial bone after corticotomy by a monorail fixator. The procedure was done in two stages where internal and external fixation was done after creating a gap at the non-union site. The bone was transported after corticotomy and fixed to the internal fixation device in the second stage. The external fixator was removed in the second stage and the patient was then followed up till the bony union. The evaluation was done by functional and radiological assessment along with the complications noted with the described procedure. Ten patients were enrolled in the study with a mean age of 33 years. The mean age of the patients was 33.7 ± 11.32 years with a mean size of the defect was 4.8 ± 1.7 cm. At 30 weeks out of nine patients, three patients had excellent and six had good functional results on the Association of Surgeons for Application and Methodology of Ilizarov (ASAMI) scale. The composite Musculoskeletal Tumor Society (MSTS) score was 76.66 % at the end of 30 weeks of follow-up. The mean time of consolidation was 134.4 days, whereas the mean union time was 145 days from index surgery. Ankle stiffness was the most common complication affecting 50% of the patients. Following closely was pin tract infection, which was present in 40% of the patients. According to Paley's classification, there were 11 obstacles, two problems and none were true complications. The integrated fixation is both safe and effective and has the advantage of early removal of the external fixator and a low complication rate as compared to use of a bulky conventional fixator alone. Moreover, it gives protection to the regenerated bone for a long period. So, this technique can be recommended for the management of segmental tibial defects.

Radiological Verification for the Suitability of Using the Quadriceps Angle to Represent Orientation of the Quadriceps Femoris.

The orientation of the quadriceps femoris can be represented by the quadriceps angle (Q-angle) has not yet been approved because of the high incidence of patellar instability. In this study, the correlations among components of the quadriceps femoris and the Q-angle using the plain radiographic technique were assessed. This retrospective study aims to use the radiographic technique to clarify these doubts from anatomic viewpoints. One hundred consecutive young adult patients (50 men and 50 women; aged, 34 ± 5 and 33 ± 6 years, respectively) who sustained chronic unilateral lower extremity injuries (unilateral femoral, tibial nonunions or malunions) were enrolled. The contralateral intact lower extremity was used for the study. The full-length standing scanogram (FLSS) was used to evaluate the rectus Q-angle (R-Q angle), vastus Q-angle (V-Q angle), and clinical Q-angle (C-Q angle; i.e., known as the Q-angle). The three Q-angles were compared statistically. The Mann-Whitney U test and the Kruskal-Wallis test were used for comparison among groups. The Spearman rank correlation coefficient was used to evaluate the degree of relationship between two groups. The C-Q angle or the V-Q angle was statistically different from the R-Q angle (p < 0.001). The C-Q angle between sexes was not different (p = 0.25). High correlation occurred among the C-Q angle, the R-Q angle, and the V-Q angles (correlation coefficient, 0.886-0.979). The multiple linear regression revealed of C-Q angle = 0.72; R-Q angle, p < 0.001 + 0.21; and V-Q angle, (p = 0.009) + 2.61° in 100 patients. Orientation of the quadriceps femoris can be represented by the Q-angle. Compared to the rectus femoris, the three vastus muscles of the quadriceps femoris are more correlated to the Q-angle.

Radiographic and functional results of Ilizarov fixation in the management of nonunion of tibia and femur fractures: a retrospective case series.

Femoral and tibial fractures may result in delayed union and nonunion, posing significant challenges in orthopedic practice. The Ilizarov technique has emerged as a promising solution for managing these complex cases. Evaluate the radiographic and functional results of Ilizarov fixation in the treatment of nonunion of tibia and femur fractures. Retrospective. Hospitals affiliated with a university hospital. Patient demographics, fracture characteristics, and treatment details were analyzed for the period from October 2015 to September 2022 in patients who were treated for nonunion of the tibia and femur using the Ilizarov fixator. Clinical and radiological assessments were performed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. The study focused on assessing the average duration for union and frame removal, bone results, successful union rates, and functional results using the ASAMI criteria, obtaining data from the existing medical records, spanning various medical facilities treating nonunion fractures. 126 patients. The average duration for union and frame removal was 8 months, with excellent bone results observed in 60.32% of cases. Out of 126 patients, 118 achieved successful union, while there were 2 failure cases necessitating amputation (1.52%). Functional results revealed excellent outcomes in 39.68% of cases. Complications included pin tract infections, ankle and knee stiffness, and limb shortening. External fixation duration and infection eradication were consistent with previous research, emphasizing the technique's effectiveness. The Ilizarov technique proved highly effective in managing nonunion tibia and femur fractures, offering favorable outcomes in terms of union, infection control, pain relief, and functional recovery. While excellent bone outcomes do not guarantee optimal function, this method remains a reliable approach for complex cases. Potential biases inherent in retrospective analyses and the need for further randomized controlled trials to comprehensively compare treatment modalities.

Salvage fixation of proximal tibia non-union and mal-union with 95° angled blade plates

Introduction: Proximal tibia non-unions and mal-unions can present particular challenges in their management because of a short proximal segment, excessive misalignment and soft tissue compromise. Available options in the management should consider the biomechanical demand of that anatomical location. The aim of this study was to determine the long-term functional outcomes of patients treated with open reduction and internal fixation with 95° angled blade plate (ABP). Materials and methods: Total of twenty nine patients with a proximal tibial non-union and mal-unions were retrospectively treated between September 2016 and March 2022. Eighteen (62%) were non-unions, and eleven (38%) were mal-unions. The male were 21 (72%) and female were 8 (18%); Right tibia in 16 patients, and left tibia in 13 patients. Among the non-unions twelve were originally closed fractures, and six were open fractures. While among the eleven mal-unions, Eight were varus deformity and three were valgus deformity. All cases were treated with a consistent approach of debridement, deformity correction, angled blade plate fixation, and with or without bone grafting. Only 5 patients who presented with non-union had bone graft. Results: All the twenty nine patients’ fixations healed within an average of 30 weeks, and alignment was within 5° of anatomic in all cases after follow up for a median 3.2 years (range 1.8 to 6.6). The average duration of union after surgery was 4.5 month (range 3 to 7.5 month). The outcome were 23 (79%) excellent; 4 (14%) good; 1 (3.5%) fair, and 1 (3.5%) poor result based clinical and radiological evaluations of pain, range of knee motion, limb length, fracture healing and overall satisfaction with daily living activities. Conclusions: For clinical and biomechanical consideration, 95° ABP could be a very suitable implant in the management of metaphyseal non-union and mal-unions of the proximal tibia with high success rate.

Polytherapy versus monotherapy in the treatment of tibial non-unions: a retrospective study.

Treating tibial non-unions efficiently presents a challenge for orthopaedic trauma surgeons. The established gold standard involves implanting autologous bone graft with adequate fixation, but the addition of biologicals according to the so-called diamond concept has become increasingly popular in the treatment of non-unions. Previous studies have indicated that polytherapy, which involves implanting mesenchymal stem cells, bioactive factors and osteoconductive scaffolds, can improve bone healing. This study aims to evaluate the efficacy of polytherapy compared with monotherapy in treating tibial non-unions of varying severity. Data from consecutive tibial non-unions treated between November 2014 and July 2023 were retrospectively analysed. The Non Union Scoring System (NUSS) score before non-union surgery, and the Radiographic Union Score for Tibial fractures (RUST), scored at 1, 3, 6, 9, 12 and 18months post-surgery, were recorded. Initially, a comparison was made between the polytherapy and monotherapy groups. Subsequently, patients receiving additional surgical non-union treatment were documented, and the frequency of these treatments was tallied for a subsequent per-treatment analysis. A total of 34 patients were included and divided into a polytherapy group (n = 15) and a monotherapy group (n = 19). The polytherapy group demonstrated a higher NUSS score (44 (39, 52) versus 32 (29, 43), P = 0.019, z = -2.347) and a tendency towards a higher success rate (93% versus 68%, P = 0.104) compared with the monotherapy group. For the per-treatment analysis, 44 treatments were divided into the polytherapy per-treatment group (n = 20) and the monotherapy per-treatment group (n = 24). The polytherapy per-treatment group exhibited a higher NUSS score (48 (43, 60) versus 38 (30, 50), P = 0.030, z = -2.173) and a higher success rate (95% versus 58%, P = 0.006) than the monotherapy per-treatment group. Within the monotherapy per-treatment group, the NUSS score displayed excellent predictive performance (AUC = 0.9143). Setting the threshold value at 48, the sensitivity and specificity were 100.0% and 70.0%, respectively. Polytherapy is more effective than monotherapy for severe tibial non-unions, offering a higher success ratio. The NUSS score supports decision-making in treating tibial non-unions. Level III.

Functional outcome of distraction osteogenesis in infected nonunion of the tibia

Abstract Background: The tibia is a bone located beneath the skin. Open fractures of the tibia, which involve significant soft tissue damage and bone loss, pose a challenge for trauma surgeons. The prevalence of long bone fractures is on the rise, attributed to the escalating number of road traffic accidents and other household mishaps, resulting in an increased occurrence of nonunion cases. Consequently, this study aims to evaluate the healing rates in long bone nonunion fractures and examine the complications associated with the treatment device. Managing infected tibial nonunions remains a formidable task for orthopedic surgeons. Materials and Methods: A retrospective study was conducted on 30 patients diagnosed with infected nonunion of tibial fractures treated with limb reconstruction systems (LRSs) in the Department of Orthopaedics at Vinayaka Missions Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India. Inclusion criteria comprised patients aged between 20 and 55 years with tibial fractures failing to unite within 6 months, radiological evidence of nonunion, willingness to provide written informed consent and suitability for surgery. Results: The results revealed that most patients fell within the age group of 40–50 years, with an average age of 40.9 years in our study. Out of 30 patients, 17 were male and 13 were female. Regarding bony results, 20 patients (66.7%) exhibited excellent outcomes, 6 patients (20%) showed good results, 3 patients (10%) had fair outcomes, and 1 patient (3.3%) had poor outcomes. Functional outcomes showed that 20 patients (66.7%) experienced excellent results, 6 patients (20%) showed good outcomes, 3 patients (10%) had fair outcomes, and 1 patient (3.3%) had poor outcomes. Conclusion: This study concludes that the LRS fixator facilitates early ambulation, reducing the risk of osteoporosis, and soft tissue dystrophy. The average union time was 4 months, influenced by comminution, infection, nonunion type, smoking, and fracture pattern.

Which surgical technique may yield the best results in large, infected, segmental non-unions of the tibial shaft? A scoping review

PurposeInfected nonunion of the tibia with a large segmental bone defect is a complex and challenging condition for the patient and surgeon. This scoping review was conducted to identify existing evidence and knowledge gaps regarding this clinical scenario. Secondly, the objective of this study was to search for a valid recommendation on the optimal treatment.MethodsA comprehensive search was conducted in the bibliographic databases: PubMed, Embase.com, and Web of Science Core Collection. Studies reporting on bone transport techniques, the Masquelet technique, and vascularized fibular grafts in bone defects greater than 5 cm were included. Bone healing results and functional results were compared according to duration of nonunion, infection recurrence, bone consolidation, complication rate, external fixation time, and time until full weight-bearing.ResultsOf the 2753 articles retrieved, 37 studies could be included on bone transport techniques (n = 23), the Masquelet technique (n = 7), and vascularized fibular grafts (n = 7). Respective bone union percentages were 94.3%, 89.5%, and 96.5%. The percentages of infection recurrence respectively were 1.6%, 14.4% and 7.0%, followed by respectively 1.58, 0.78, and 0.73 complications per patient.ConclusionBone transport was found to be the most widely studied technique in the literature. Depending on the surgeon’s expertise, vascularized fibular grafts may be held as a favourable alternative. This review indicates that further high-quality research on large bone defects (≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 5 cm) in patients with infected tibial nonunions is necessary to gain more insight into the potentially beneficial results of vascularized fibular grafts and the Masquelet technique.

Outcome of Bone Transport Using Ilizarov External Fixator in Infected Non-union of Tibia with Large Bone Defects: Comparison of Those with 5-10cm Bone Defect with Those Having ≥ 11cm Bone Defect.

Ilizarov external fixation has become the treatment of choice for infected non-union of tibia. Varying degrees of bone loss and different strategies of treatment in the published reports make comparingoutcomes difficult. This study hopes tobridge thisgapin the literature by focussing exclusively on bone transport in patients with bone loss of 5cm or more. Thisis a prospective case series conducted at a tertiary level orthopaedic speciality hospital. Outcomes are measured by Association of the Study and Application of Method of Ilizarov (ASAMI) bony scores, ASAMI functional scores, Lengthening Index and by assessing complications encountered. There were 49 patientsin this study withan average of 9.57cm bone gap. Among these,29 patients had a bonegap of 5-10cm and 20 patientshad a bone gap of ≥ 11cm.According to the ASAMI bony score, 42 patients had excellent or good outcomes with two fair results and five poor results. The ASAMI functional scores were 45 excellent to good outcomes, four fair and no poor results or failures. Fixed flexion deformity of the knee of more than 5°, ankle stiffness and soft tissue interposition were significantly more frequent in those with bone gap of ≥ 11cm. Trifocal transport and bone grafting at docking significantly improved the lengthening index. Even massive bone defects of 11cm or more can be reliably healed by bone transport using Ilizarov external fixation, but with a significantly higher rate of complications. Level IV.

Resistant and Refractory Distal Tibia Non-Union Using an Intramedullary Free Fibular Graft and Ilizarov Fixation – An Illustrative Case Report

Introduction: Resistant and refractory non-union of distal tibia extra-articular fractures is very common even following internal fixation due to poor blood supply to the distal tibia metaphyseal region. The management can be challenging. Case Report: A 50-year-old diabetic male had sustained closed distal tibia extra-articular fracture at the junction of diaphysis and metaphysis. Intramedullary interlocking nailing was done elsewhere. The fracture did not unite. Nail removal, bone grafting, and plate fixation were done elsewhere. The fracture did not unite and implant failure occurred. The nonunion was successfully managed by plate removal, intramedullary free fibula bone grafting, and Ilizarov fixation. Union required 6 months but patient finally was able to return to his work with good function and without any signs of infection. Conclusion: This case illustrates the successful incorporation of a stabilized intramedullary fibula graft which enabled union of a resistant distal tibia fracture nonunion. Keywords: Resistant tibia non-union, avascular fibular strut graft, distal tibia non union, ilizarov fixation

A rare managed case of extra articular proximal tibia nonunion with implant failure with severe virus deformity

A rare managed case of extra articular proximal tibia nonunion with implant failure with severe virus deformity

Management of Infected Non-Union of Tibia Treated with Ilizarov External Fixator and Fibular Graft; Our Experience

Management of Infected Non-Union of Tibia Treated with Ilizarov External Fixator and Fibular Graft; Our Experience

PRECICE nail for the management of posttraumatic bone defects with nonunion or malunion: Experience from a Latin American center

BackgroundTo evaluate the clinical outcomes using the PRECICE magnetic limb lengthening intramedullary nail for the correction of lower limb length discrepancies (LLD) in adults with posttraumatic nonunion or malunion defects in a Latin American center. MethodsA retrospective review of 25 adult patients with LLD associated with posttraumatic nonunion or malunion defects of femur or tibia treated with the PRECICE nail between January 2018 and December 2020. The primary outcomes considered were lengthening length achieved in mm, incidence of complications and quality of life (EQ-5D-3 L questionnaire). ResultsTwenty-five cases (20 femoral and 5 tibial nails) were performed, with a median follow-up of 27 months (Interquartile range-IQR: 17.5 to 34.5). The average age was 36.5 ± 12.9 years; 10 cases were women. Fifteen cases had an LLD secondary to a malunion defect and 10 cases had an LLD secondary to a nonunion. PRECICE nails were inserted for the treatment of a median LLD of 40.0 mm (IQR: 30.2 to 74.2) in the femur and 30.0 mm (28.5 to 50.0) in the tibia. An accuracy of 100% was reported in 18 cases (Femur: 14 and tibia: 4) and consolidation was achieved in 22/25 cases with the PRECICE nail in situ. Complications were recorded in 9 (36%) cases (6/20 femur, 3/5 tibia), mainly related to the consolidation process (5/9). The median EQ-5D and EQ-VAS were 0.79 (IQR: 0.63 to 0.79) and 80.0 (IQR: 50.0 to 90.0), respectively. ConclusionsThe results of this study demonstrated that the PRECICE nail is an effective device for the management of posttraumatic LLD during the treatment of nonunion or malunion bone defects of femur and tibia, offering a reasonable quality of life, despite its postoperative complication risk.

Gentamicin[sbnd]coated tibial nail is an effective prevention method for fracture-related infections in open tibial fractures

Fracture-related infection (FRI) is a common complication following open tibia fracture (OTF), especially in patients with high-energy trauma or comorbidities. The use of gentamicin-coated nail (GCN) has been proposed as a local adjuvant to prevent FRI in high-risk patients.Hypothesis: The incidence of FRI is expected to be lower in OTF treated with a GCN, alongside with no detrimental effects on fracture healing time.Objectives: This study aimed to evaluate the effectiveness of GCNs as a definitive fixation method and prophylaxis for FRI in OTFs. Secondary outcomes included non-union rates and time to healing.Methods: The study design was a mixed cohort, including a prospective group of patients treated with GCN (Expert Tibial Nail PROtect™, Depuy Synthes, Johnson&Johnson Company Inc, New Jersey, USA) and a retrospectively evaluated group treated with non-gentamicin-coated nail (NGCN). Patients with at least 12 months of follow-up were included. The treatment protocol consisted of timely administration of antibiotics, surgical debridement, and early soft-tissue coverage. Exclusion criteria included protocol infringement, traumatic amputation, and loss of follow-up.Statistical analysis was performed using Stata v14.0, with a significance level of p < 0.05.Results: The study included 243 patients, 104 in GCN group and 139 NGCN group. External Fixator use was higher in the NGCN group, but this did not significantly affect the FRI rate.GCN use was associated with a significantly lower incidence of FRI (2.88% GCN group vs. 15.83% NGCN group, OR 0.16, p < 0.01). Furthermore, GCN use was found to be a protective factor against tibial non-union (OR 0.41, p = 0.03). There were no adverse effects attributed to locally administered gentamycin. The NGCN cohort had a higher incidence of polytrauma, although the difference was not statistically significant. A longer time to heal as well as more FRI and Non-union according to the progression in Gustilo-Anderson classification was observed in the GCN group.Conclusion: Our findings suggest that GCN is an effective prophylactic method to reduce the risk of FRI in open tibial fractures at 12-month follow-up, as well as, probably derived from this protective effect, leading to lower fracture consolidation times when compared with cases treated without GCN.

Tibio-Fibular Fusion by Posterolateral Approach to Treat Nonunion of Tibia

A 30- year- old male has sustained open fracture of left leg and undergone 4 surgeries for four years (1. debridement and external fixator, 2. removal of external fixator, 3. vascularized contrafibular autograft plus change new plate/screws of ipsifibula, 4. flap surgery to cover the wound). At the time of examination: unability to walk, abnormal movements of leg, tibial bone loss 8 cm, especially the soft tissue of almost total anterior leg was so bad: no more subcutaneous tissue, skin very next to bone decouraging any attempt anterior approach. Diagnosis: pseudarthrosis of left leg with tibial large bone loss in the status of seriously damaged soft tissue of anterior leg surface. Technique operation chosen: Posterolateral. Appoach, Tibiofibular Fusion with massive autocancellous bone graft harvested from posterior iliac pelvis. Casting 4 months (from midthigh to metatarsal head). Postoperative walking with two crutches, Full Weight Bearing allowed after 14 weeks. Removal of cast after 16 weeks. Full knee flexion obtained 8 weeks after cast removal. Review at tenth month: normal walk, slight running, complete knee Range of Motion, 5. degree loss of dorsiflexion of ankle. X-rays: good fusion proximal and distal tibiofibular spaces and partly fusion the tibio-tibial gap. By this case,we can resumably conclude Tibiofibular Fusion through Posterolateral Approach should be strongly indicated for the leg nonunion in which the soft tissue of anterior surface is not favorable for nearby approach.

A comparative study of Ilizarov ring fixators and limb reconstruction system fixators in the treatment of compound tibial shaft fractures

Background: Tibia is the most commonly fractured long bone, and the prevalence of compound fractures has risen due to an increase in high-energy traumatic incidents. In addressing challenging tibial fractures with significant soft tissue damage, infected tibial nonunion, and compound tibial fractures, medical professionals have turned to specialized treatments, such as Ilizarov ring fixators and limb reconstruction system fixators. These fractures typically cannot be managed effectively with traditional internal fixation methods. To facilitate early weight-bearing, limb lengthening, and efficient wound care, two minimally invasive fixation systems have been developed: the Limb Reconstruction System and the ring fixator. Methods: The study was conducted on 40 patients with compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators with the aim to evaluate the functional outcome, union rate and amount of limb lengthening using Ring and ILRS fixators in compound tibial fixators. Results: In our study, a significant portion of the participants fell within the age range of 28 to 37 years, comprising 45% of the total sample. Furthermore, the majority of the study subjects were male, constituting 65% of the participant pool. The primary mode of injury reported in our study was road traffic accidents, accounting for 77.5%. Conclusions: The study concluded that LRS fixators show good and promising results like easy to apply, carry, compress, distract and clean while Ilizaro ring fixator is technically demanding, difficult to carry and cumbersome to the patient.