Tibial Union Research Articles

Bone union and mobility outcomes for reconstructed open tibial fractures: a plastic surgical experience from a major trauma center.

The goal in open tibial fracture management is to achieve a united tibia in an extremity that allows pain free mobilization. The objective of this study was to assess factors that lead to this functional outcome in lower limb reconstruction, from a plastic surgical perspective. The Plastic and Reconstructive Surgery lower limb database at a tertiary trauma hospital was searched for open tibial injuries from February 2015 to March 2020. The nature and severity of injury, timing and details of all operations including reconstructions were collected prospectively. Mobility including gait aids, pain, and complications were retrospectively collected. Union was assessed in two ways, depending on fracture location. Metaphyseal and diaphyseal tibial fractures were provided mRUST scores (union defined as RUST > 13) and epiphyseal tibial fractures were categorically classified as "united" or "non-union" by two independent radiologists. During the five-year study period there were 148 open leg injuries in the database. Twenty-one patients underwent a primary amputation due to severity of their initial injury. One hundred patients underwent primary limb salvage. Sixty-one patients in the limb salvage group achieved primary tibial union with a mean follow-up time of 19.4 months post injury. Twenty-three additional patients were confirmed to subsequently unite. Patient who achieved union were more likely to mobilise without gait aids. In this study definitive external fixation and soft tissue infection were both associated with higher rates of non-union. Longer times to soft tissue reconstruction was not associated with an increase in acute soft tissue complications. More importantly bone union, pain and mobility did not decline. After undertaking a primary limb salvage pathway for 100 patients, the ultimate tibial fracture union rate was 84% and the confirmed ambulation rate was 96%.

The role of fibula fixation in combined distal-third tibia and fibula fractures: a systematic literature review.

The role of concomitant fibula fracture fixation in distal-third tibia fractures regarding alignment, union, and functional outcome is still a topic of debate. In this review, we summarize the available comparative literature regarding fibula fixation in distal third lower leg fractures. A systematic literature review of articles published between January 2000 and January 2022 in the PubMed, Cochrane, and EMBASE databases about this topic was performed. 746 unique studies were identified of which four randomized-controlled trials and six retrospective studies were included. Nine studies compared alignment after tibia fixation with or without fibula fixation, six studies reported on tibial union, and three studies reported on functional outcome between groups. Pooling of data was not possible due to varying outcome measures and inclusion criteria. Fibula fixation was associated with less rotational malalignment, while there does not seem to be consensus regarding the effect on sagittal and coronal alignment. Six studies reported on the effect of fibula fixation on tibial union. None of these studies found a significant difference between treatment modalities. Furthermore, one out of three studies reporting functional outcome described a marginal beneficial functional outcome after fibula fixation. Ultimately, no differences in complication rates between treatment modalities were described. Fixation of the fibula in distal-third lower leg fractures does not seem to have a significant effect on coronal and sagittal tibial alignment. Furthermore, fibula fixation is associated with significantly less rotational malalignment, although the clinical importance of this finding is questionable as true differences in rotational alignment between treatment modalities are small. Finally, fibula fixation does not affect union, functional outcome, or complication rate as adjuvant to tibia fixation. II.

Treatment of Concomitant Congenital Pseudarthrosis of the Fibula With Propeller Periosteal Flap.

Congenital pseudarthrosis of the fibula is not an uncommon condition to accompany congenital pseudarthrosis of the tibia. Persistence of the fibular pseudarthrosis has been linked to inferior outcomes including tibial union and alignment, refractures, and ankle alignment. In this report, we present the results of a pedicled periosteal propeller flap technique for the treatment of fibular pseudarthrosis. Ten children with an average age at surgery of 5.3 years who had congenital pseudarthrosis of both tibia and fibula were studied. The tibia was treated with free vascularized fibular grafting, and the ipsilateral fibula was treated with a technique after resection of the pseudarthrosis. A periosteal flap from the proximal healthy part of the fibula is harvested off the bone, rotated 180° based on a branch from the peroneal vessels to cover the fibular defect and fashioned in the form of a tube filled with bone fragments. The periosteal flap size ranged from 5 to 7 cm. Follow-up averaged 37.2 months. The tibia was united in all cases; in 2 of them, refractures occurred and healed with conservative management. The fibula was united in 8 cases. At final follow-up, 5 cases showed residual tibial deformity, and 5 showed residual ankle deformity. Average leg-length discrepancy was 1.4 cm (0-3 cm). The pedicled periosteal propeller flap presents a useful new technique for managing concomitant congenital fibular pseudarthrosis.

Fibular Fixation in Same-Level Distal Third Tibiofibular Fractures: Is Fibular Fracture Regarded as a Secondary Importance?

Although most studies focused on the alignment or union of the tibia in same-level distal third tibiofibular fractures, the outcome of a concomitant fibular fracture is generally regarded as being of secondary importance in the literature. This study aimed to assess the outcomes of fibular fractures in same-level distal third tibiofibular fractures. In this retrospective study, we enrolled 111 patients with same-level distal third tibiofibular fractures treated at our institute between January 2016 and August 2020. Tibial fractures were stabilized with intramedullary nailing, and the cases were divided into two groups based on whether they additionally underwent fibular fixation (group 1, 57 cases) or not (group 2, 54 cases). Clinical and radiographic outcomes were used for the evaluation of tibial and fibular alignments, union of the tibia and fibula, number of interlocking screws in the distal tibial fragment, range of motion of the ankle joint, and complications. No statistically significant differences in the tibial union rate or mean tibial alignment were observed between the two groups on either the immediate postoperative or final radiographs. The fibular union rate in group 1 was significantly higher than that in group 2 (fibular nonunion, 0 vs. 15; p < 0.001). Statistically significant differences in fibular displacement were observed on immediate postoperative radiographs between patients with fibular union and those without it. At the final follow-up, the mean range of ankle motion and lower extremity functional scale scores did not differ between the two groups. Regardless of whether fibular fixation was performed, the overall tibial alignment with intramedullary nailing was well restored and the union rate of the tibia was comparable in the two groups. Fibular nonunion is not uncommon in unfixed fibula fractures. Displacement of the fibula as seen on immediate postoperative radiographs was related to fibular nonunion.

Novel method for the treatment of congenital pseudarthrosis of the tibia using the gastrocnemius flap: A preliminary study.

Purpose:Congenital pseudarthrosis of the tibia is a rare disease that is particularly difficult to treat; the most difficult complications include nonunion of the tibia, refracture, and failed surgery. This study aimed to evaluate the efficiency of transposing gastrocnemius flaps for the treatment of congenital pseudarthrosis of the tibia.Methods:Nine patients (aged 6.2 ± 3.6 years) diagnosed with congenital pseudarthrosis of the tibia in our hospital between March 2013 and March 2018 were enrolled. The tibial pseudarthrosis and thickened periosteum were completely removed, and intramedullary nails were used to fix the tibia. Bone harvest from the iliac, mixed with allogenic bone, was filled in the gap created by excision of the pseudarthrosis site and the surrounding periosteum; the gastrocnemius flap was then used to wrap the pseudoarthrosis site. The plaster cast was fixed postoperatively. The tibial union was evaluated via radiograph, and the plaster cast was removed after 12–24 weeks. Patients began walking approximately 12–14 weeks postoperatively.Results:Anatomical reduction was achieved in all the patients; the mean bone healing time was 10.1 ± 2.1 months. Bone nonunion was observed in one patient, and no neurovascular injury or wound infection occurred. Limb length discrepancy was in the range 3.2 ± 1.8 cm at 1 year and 4.7 ± 2.7 cm at 2 years after surgery. Two patients underwent replacement of the intramedullary nail, and eight patients exhibited good functional and radiographic outcomes.Conclusion:This preliminary study proved that using the gastrocnemius muscle flap to cover the pseudarthrosis site was an effective method to promote the tibial union and treat congenital pseudarthrosis of the tibia.

The spectrum of tibial pseudarthrosis with constriction band syndrome in children.

Constriction band syndrome (CBS) may be rarely associated with pseudarthrosis of tibia. Published literature includes only case reports. We evaluated the outcome of children with frank pseudarthrosis of the tibia with CBS and compared our results with other reported cases. We aimed to formulate a clinical classification of tibial involvement in CBS on the basis of the treatment guidelines. Seven patients with the presence of one or more constriction bands and radiological signs of tibial pseudarthrosis were included in the study. Eight reported cases of CBS with tibial involvement with management and follow-up details were reviewed. Only two tibial pseudarthrosis united spontaneously after the release of the constriction band. Two patients underwent simultaneous correction of tibial deformity and nailing with band release, one of which needed bone grafting for the pseudarthrosis union. Three patients subsequently needed an excision of tibial pseudarthrosis with nailing to achieve tibial union, two of them had autologous bone grafting along with nailing. Additional procedures were required for the correction of foot deformity and limb length discrepancy. Our findings were similar to the reported cases. The pseudarthrosis of the tibia with CBS does not always heal following band release. Additional surgeries may be required for persistent pseudarthrosis, limb length discrepancy and residual foot deformities. A functional and radiological classification is proposed for the treatment of tibial pseudarthrosis with CBS.

Comparison of Ilizarov and rail fixator in non union of long bones

Introduction: Non-union of long bones is a challenging scenario to deal with as management of such fractures is difficult. Tibia is common site of non union.1 Various modes of treatment are available such as ultrasound, electrical stimulation, bone grafting and bone transport by illizarov and rail fixator. We have compared the role of Ilizarov and Rail fixator devices in our study of 15 patients each under both groups. Only Rail fixator had some more patient tolerance as compared to Ilizarov due to problems such as heavy apparatus. Materials and Methods: 15 patients of non union long bones in each group from 21 to 60 years with mean age of 37.6 year in group A and 40.5 years in group B. 90% of the patients were male. Most of the patients had non union of tibia and further the middle one third was more commoly involved in either group. Nine out of 15 patients in both the groups had infected type of non-union. Average shortening was 2.9 cm in group A and 2.86 cm in group B. Maximum number of patients had undergone about two previous surgeries. 12 patients underwent acute docking or compression in group A compared to 13 in group B. Three and two patients underwent compression – distraction for treatment of non union in group A & B respectively. Patients were followed up at 6, 12 and 24 week intervals. Result: In our study union was seen in 13 cases in group A and 14 cases in group B. The duration for union was average 8.8 months and 8.1 months in respective groups. Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 80% of the cases in Group A and 86% of cases as per ASAMI scoring system. Conclusion: Bone results were more or less similar in both the groups. Functional results were a bit better in rail fixator group. Rate of complication were also similar in our study. However patients tolerated rail road with ease and application of rail fixator and comfortable distraction procedure had marginal benefit over Il

Effect of anatomic fibula on tibia union and alignment after intramedullary nailing of tibia shaft fractures

Objectives: The effect of an intact or fixated fibula on tibial union and alignment in tibial shaft fractures applied with intramedullary nailing is investigated.Methods: A retrospective examination was made of 67 patients aged 19-85 years who were applied with intramedullary nailing for a tibial shaft fracture (AO-42) between January 2010 and December 2016. The 44 patients included in the study were separated into 2 groups as those with anatomic fibula (Group 1, n = 12) and those with a fibula fracture which is not fixated (Group 2, n = 32). The patients were evaluated in respect of bone union and malalignment from direct radiographs. Union was evaluated according to the RUST criteria, and the threshold for malalignment was taken as 5˚ in the coronal and sagittal planes.Results: The patients comprised 24 males and 20 females (M/F: 6/5) with a mean age of 42.7 years (range, 19-76 years). Non-union was observed in 3/12 patients (25%) in Group 1, and in 2/32 (6.3%) patients in Group 2 at 6 months. Malalignment was observed in 1/12 (8.3%) patients in Group 1 (procurvatum) and in 7/32 (21.8%) patients in Group 2, of which 3 (9.3%) were varus, and 4 (12.5%) were valgus. The rate of malalignment was significantly lower in Group 1 than in Group 2.Conclusions: The results demonstrated that bone union of a tibial shaft fracture is slower in patients with an anatomic fibula compared to those with non-anatomic fibula. Although the anatomic fibula slows the rate of union, it prevents malalignment.

Role of Ilizarov’s ring fixator for treatment of infected nonunion of Tibia

Infection is the most dreaded complication of the surgery and management of the infected non-union bones is also a challenging task. The aim of our study is to evaluate the efficacy of Ilizarov’s ring fixator in the treatment with infected nonunion of tibia. 17 patients were included in our study. Rate of union was 100%. 10 patients had excellent results, 5 patients had good result and 2 patients had fair result. The minimal duration for union was 9 months with average duration lasting for 12 months. One patient needed a bone marrow injection at 2 month follow-up. Ilizarov ring fixator is an effective tool in treating Infection Non Union of Tibia and is a limb salvage procedure. Keywords: Ilizarov’s ring fixator; infected nonunion; tibia

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia\u2014a retrospective comparative analysis

IntroductionThis study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia.Material and methodsIn a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000–2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity.ResultsUnion rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827).DiscussionOur study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

Descriptive study of outcome of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of weight bearing long bones

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Infected non-union of tibia and femur is a debilitating disorder for patient as well as challenging task for treating surgeon. Conventionally treatment of infected non-union is a two staged procedure. But antibiotic cement-impregnated intramedullary nailing (ACIINs) is a single staged and cost-effective procedure. Hence we intended to study the outcome of ACIIN use in infected non-union of tibia and femur.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a hospital based prospective case series type of descriptive study conducted in Department of Orthopedics, SMS Medical College and Hospital, Jaipur. We studied 35 cases of infected non-union of femur and tibia fracture with interlock nail in situ. All patients were treated with interlock nail removal, debridement and freshening of sclerosed bony ends and fixation with ACIIN. All were followed for at least 6 months for infection control and bony union and final results were evaluated by Paley’s bony criteria and functional criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Infection was controlled in 94.28% cases. Bony union was achieved in 88.57% cases (19 femur and 12 tibia). Average duration for bony union was 7.3 months for femur and 8 months for tibia. According to Paley’s criteria for bony outcome and functional outcome 65.71% and 51.43% had shown excellent outcome respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ACIIN is a good modality for treatment of infected non union of tibia and femur in terms of infection control and bony union and has a good functional outcome when bone gap is less.&lt;/p&gt;

Identification and characterization of NF1 and non-NF1 congenital pseudarthrosis of the tibia based on germline NF1 variants: genetic and clinical analysis of 75 patients

BackgroundCongenital pseudarthrosis of the tibia (CPT) is a rare disease. Some patients present neurofibromatosis type 1 (NF1), while some others do not manifest NF1 (non-NF1). The etiology of CPT, particularly non-NF1 CPT, is not well understood. Here we screened germline variants of 75 CPT cases, including 55 NF1 and 20 non-NF1. Clinical data were classified and analyzed based on NF1 gene variations to investigate the genotype-phenotype relations of the two types of patients.ResultsUsing whole-exome sequencing and Multiplex Ligation-Dependent Probe Amplification, 44 out of 55 NF1 CPT patients (80.0%) were identified as carrying pathogenic variants of the NF1 gene. Twenty-five variants were novel; 53.5% of variants were de novo, and a higher proportion of their carriers presented bone fractures compared to inherited variant carriers. No NF1 pathogenic variants were found in all 20 non-NF1 patients. Clinical features comparing NF1 CPT to non-NF1 CPT did not show significant differences in bowing or fracture onset, lateralization, tissue pathogenical results, abnormality of the proximal tibial epiphysis, and follow-up tibial union after surgery. A considerably higher proportion of non-NF1 patients have cystic lesion (Crawford type III) and used braces after surgery.ConclusionsWe analyzed a large cohort of non-NF1 and NF1 CPT patients and provided a new perspective for genotype-phenotype features related to germline NF1 variants. Non-NF1 CPT in general had similar clinical features of the tibia as NF1 CPT. Germline NF1 pathogenic variants could differentiate NF1 from non-NF1 CPT but could not explain the CPT heterogeneity of NF1 patients. Our results suggested that non-NF1 CPT was probably not caused by germline NF1 pathogenic variants. In addition to NF1, other genetic variants could also contribute to CPT pathogenesis. Our findings would facilitate the interpretation of NF1 pathogenic variants in CPT genetic counseling.

External axial stress in induction of rabbit tibia fracture healing

Objective The objective of this study was to investigate whether postoperative rapping by external axial stress stimulator can accelerate rabbit tibial fracture union by analyzing the expression of vascular endothelial growth factors (VEGF), CD34, bone morphogenetic protein-2 (BMP-2) and transforming growth factor-β1 (TGF-β1) in different periods osteotylus. Methods New Zealand rabbit tibial fracture models were randomly divided into two groups. Experimental group received stress stimulation for 30 minutes every two days began at postoperative 8 days. Lane-Sandhu X-ray evaluation system was used to evaluate the bone healing process at 2, 4, 6 and 8 weeks. Specimens (n=6) were obtained for immunohistochemical test and semi quantitative analysis to compare the expression of VEGF, CD34, BMP-2 and TGF-β1 at postoperative 2, 4, 6 and 8 weeks. Results (1) The mean Lane-Sandhu X-ray score in experimental group was significantly higher than controlled group with more osteotylus quantity at 4, 6 and 8 weeks. At 4, 6, 8 weeks postoperation, the score of experimental group (5.33±0.54, 7.00±0.82, 9.67±0.47) was significantly higher than the control group (3.67±0.15, 5.67±0.44, 7.08±0.32, P<0.05). (2) The VEGF in the experimental group reached the peak at 4th week after operation, the density (mean) in the experimental group was (532.50±13.50) higher than that in the control group (319.18±12.09), P<0.05; BMP-2 peaked at the 6th week after operation and the density (mean) of the experimental group was reached. (571.79±7.97) was higher than that of the control group (296.10±12.99, P<0.01). CD34 peaked at the 4th week after operation, the density (mean) in the experimental group was (451.69±40.94) higher than that in the control group (252.65±14.49, P<0.01); TGF-β1 peaked at the 4th week too, the density (mean) in the experimental group was (433.78±3.41) higher than that in the control group (249.41±12.03, P<0.01). Conclusion Postoperative rapping by external axial stress stimulator can promote the expression of VEGF, CD34, BMP-2 and TGF-β1, stimulate vascularization and osteogenesis in the fracture site of rabbit tibia, therefore, accelerate the fracture union. Key words: Fracture union; Stress stimulation; Vascular endothelial growth factors; CD34; Bone morphogenetic protein-2; Transforming growth factor-β1

Presentation and management outcome of tibial infected non-union with Ilizarov technique.

Objective:To document the presentation of tibial infected non-union and analyze the management outcome with Ilizarov technique in terms of bone results, functional outcome, bone transport time, external fixation time, external fixation index and any complications.Methods:This case series was conducted at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Civil hospital, Quetta over a period of 3-years.Results:There were 56 patients with 53(94.64%) males and 3(5.35%) females. The age range was 16-50 years with a mean of 32.58±9.98years. According to ASAMI criteria, bone results were excellent in 37(66%), good in 10(17.85%), fair in 6(10.71%) and poor in 3(5.35%). The functional results were excellent in 37(66%), good in 9(16%), fair in 7(12.5%) and poor in 3(5.35%). The bone union rate was 98.21%.Conclusion:Ilizarov method beautifully addresses the formidable issue of infected non union of tibia with good outcome in terms of bone healing and infection eradication. The treatment period is relatively lengthy and hence patience on part of patient as well as the surgical team is imperative for achieving favourable outcomes.

Congenital pseudoarthrosis of the tibia: role of the fibula

Objective Congenital pseudoarthrosis of the tibia is still a mystery and a great challenge to pediatric orthopedic surgeon. Owing to the different morphology of congenital pseudoarthrosis of the tibia, there are many treatment options with many debatable points. The fibula is a main strut that protects the tibial union and has implications on the orientation of the ankle. Patients and methods Nine patients had congenital pesudoarthrosis of the tibia, and their average age at the time of operation was 3.8 years; four of these nine patients had intact fibula (group 1), whereas five had associated pseudoarthrosis of the fibula (group 2). The treatment method was decided depending on the condition of the fibula, whether it was intact or affected by pseudoarthrosis. In cases with intact fibula, tibiofibular fusion was done. However, in cases with associated fibular pseudoarthrosis, the pathologic pseudoarthrotic tissues were resected and the tibia and fibula were fixed with intramedullary wires and Ilizarov ring fixator. Results A union rate of 100% was achieved without a refracture till the last follow-up. Good tibial alignment was achieved in all cases, and wide cross-sectional area at the pseudoarthrosis site was obtained in all cases. One case with fibula plus +1 position was complicated with a varus deformity of the ankle. Conclusion Addressing the fibular problem safeguards against refracture and protects against ankle joint deformity. Achieving tibial union with wide regenerate or wide fusion mass, good tibial alignment and fibular union is mandatory for preventing refracture. The article was level of evidence IV.

STUDY OF MANAGEMENT OF OPEN TYPE IIIa AND TYPE IIIb FRACTURE OF TIBIA BY LIMB RECONSTRUCTION SYSTEM

Background: Management of compound tibia and femur fractures is difficult due to the presence of infection, bone loss, shortening and multiple surgeries in the past .open wound of lower limb are traditionally managed by Ilizarov fixation. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. We conducted a study on 20 compound tibia and femur fractures treated by the limb reconstruction system (LRS). Method and Materials: A prospective analysis of compound fracture of tibia type IIIa and III was done, cases treated from jan 2012 to june 2016 were included, which were treated with LRS application. this patient who had a minimum period of 6-24 month follow up from the day of initiation of treatment. 10 cases of compound tibia IIIa and 10 cases 0f IIIb were included in study . status of wound was classified by Gustello -Anderson open wound criteria ,comorbidies were noted ,additional procedure if any were noted. radiological union was defined as minimum of 3 cortical continuity in views of X-Ray. time duration was recorded in which knee Range of motion was assessed by ‘hand goniometry during treatment. Result: Average age of patient was 37.9 year , tibial showed total 100% fracture united. Average time tibial union was 10.2 month . Average time for tibial LRS in situ was 10.6 month . 6 patient required corticotomy with lengthening .Average lengthening was 2.5 cm in 7 no cases (1.5-5 cm range). Average knee rom is 100 degree of flexion(range90-130) complication noted were 1) pin tract infection 2) Delayed or Non union 3) multiple surgeries 4) patients co-operation

Ilizarov bone transport as a treatment of congenital pseudarthrosis of the tibia: a long-term follow-up study.

PurposeMost studies on congenital pseudarthrosis of the tibia (CPT) report on the short-term union rate and refracture rate but do not take into account the long-term outcome. This review includes patients treated with an Ilizarov bone transport, who all reached skeletal maturity. It describes long-term results and highlights any prognostic factors that could predict the final outcome. MethodsThe records of patients with CPT treated with an Ilizarov bone transport in our institution were retrospectively evaluated.ResultsA total of 12 consecutive patients were studied. The mean follow-up was 24.5 years (range 6–39 years). Primary consolidation was seen in ten patients (83 %). Half of these patients had a refracture. At final follow-up, eight patients experienced union and four remained un-united, of whom one had an amputation.ConclusionsThe present data confirm a good primary healing rate. However, tibial union at final follow-up was only seen in 67 %, indicating that refracture is the main issue. United bone is often of inferior biological and mechanical quality, so lifetime protection with intramedullary devices, braces or a combination of both is recommended.

Effectiveness of ilizarov frame fixation on functional outcome in aseptic tibial non-union cases at Abha, Kingdom of Saudi Arabia: An experimental study

Abstract Objectives The Objective of the study is to evaluate the effect of Ilizarov frame fixation on functional outcome in aseptic tibial non-union cases. Methods In this clinical study, 12 cases of post-traumatic aseptic tibial non-union were selected. After blood analysis and clinical assessment, the aseptic nonunion cases underwent ilizarov fixation for their problem. The pre and post-surgery functional outcome was measured by modified functional evaluation system by Karlstrom-Olerud. Results Out of the 12 patients, 3 females and 9 males, 5 had non-union of type A and were treated by compression technique. the other 7 had non-union of type B and were treated using bone-transport. Tibial union was achieved in all the cases. The functional outcome has shown 4 good, 2 satisfactory, 4 moderate and 2 poor. Conclusion The Ilizarov technique is an effective method in treating the aseptic tibial non-union.

Do Fibula Nonunions Predict Later Tibia Nonunions?

The purpose of this study was to evaluate the validity of fibula nonunion as a method for predicting tibia nonunion in the tibiofibula shaft fracture. Retrospective study. University hospital. From March 1998 to October 2008, 224 patients were enrolled. Among 224 patients, 153 patients were treated with intramedullary nail, 34 patients were treated with external fixator, 32 patients with plate and screws. The remaining 5 patients were treated nonsurgically with cast or brace. Patients followed up at 1, 2, 3, 6, 9, 12, and 18 months postoperatively. Multivariate analysis of the relationship between fibula and tibia union was conducted. Among the 224 patients, 169 patients were included in the fibula union group and 55 patients were in the fibula nonunion group. Mean age was 49 years (19-89 yrs); follow-up period was more than 18 months (18-109 mo). In the fibula union group, there were 21 patients (12.4%) with a tibia nonunion. In the fibula nonunion group, 21 patients (56.3%) had tibia nonunion. Fibula nonunion was significantly statistically associated with tibia nonunion (P = 0.002). Union time between the tibia and the fibula was statistically significant (P = 0.002). Fibula nonunion is a good predictor of tibia nonunion in patients with tibiofibula shaft fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Reconstruction of Nonunion Tibial Fractures in War-Wounded Iraqi Civilians, 2006–2008

To describe medical care and surgical outcome after functional reconstructive surgery in late-presenting patients who already had at least one prior operation. Retrospective review of medical care and surgical outcome from August 2006 to December 2008 using patient records for initial data with active follow-up for the latest outcome information. Médecins sans Frontières surgical programme in Jordan Red Crescent Hospital, Amman, Jordan. Sixty-two civilians with nonunion tibial fractures caused by war-related trauma in Iraq; 53 completed follow-up. Amputation and/or reconstruction. Late surgical complications (after the patient's return to Iraq) were analyzed for infection recurrence, bone union, and functional condition (defined using the Short Musculoskeletal Functional Assessment score). Almost three fourths of patients arrived with infected injuries, 9 of whom had amputation as the initial surgery; the rest, and all uninfected patients, had reconstruction. Excluding loss to follow-up, only 4 of 53 (8%) patients who arrived with an infected injury had infection recurrence. Excluding loss to follow-up and amputation, 2 of 14 (14%) patients in the uninfected and 5 of 30 (17%) in the infected injury group did not achieve successful tibial union. Mean Dysfunctional and Bothersome Indices overall were 27.1 and 29.8, respectively, with similar results for all 3 groups (amputations, uninfected, and infected injuries). Our study shows that patients with infected and uninfected injuries surgically treated in Amman achieved similar outcomes. Despite late presentation, our patients had a comparable outcome to other studies dealing with early reconstruction. Reconstruction for the infected group required longer treatment time. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.