Infected nonunion of the tibia represents a major challenge to orthopaedic surgeons. Heretofore, there has still been a challenge for orthopedic surgeons about the treatment of infected nonunion of tibia and femur 35. In tibial fractures, the rate of nonunion is close to 1. These fractures are common and cause physical limitations and pain to the patients. The aim of this study was to examine the ability of human adipose derived pericytes to heal a fracture destined to progress to an atrophic nonunion in a rat tibia model and to compare this to. Read the treatment of open tibial fractures and of tibial nonunion with a novel external fixator, injury on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips.
To access free multiple choice questions on this topic, click here. Sixteen blade plates were performed in patients with a diagnosis of clinical infection and all progressed to union and resolution of infection. Tibia fracture patterns in men differed from those in women. Patients with nonunion were more likely to have additional fractures. Problems with bone healing, alignment, or infection can occur after bone trauma. Management of tibial nonunion with tricalcium phosphate. Nonunion of bone following fracture is an orthopaedic condition with a high. A survey of eightyfive ununited fractures of the shaft of the tibia and one hundred control cases with simitar injuries. Depending on the type and location of the nonunion, treatment options include various types of bone fixation, with or without supplemental bone graft or other biophysical enhancements. In the present study, we examined the effects of lipus as a treatment for athletes with delayed and nonunion stress fractures of. When a fracture heals in a deformed position or with shortening of the limb, this is called a malunion. Chondrosarcoma following free fibula transfer for non. We retrospectively studied infected nonunion of distal tibia which have deformity, bone gaps and eradication of infection using ilizarov technique. Non displaced tibial shaft fractures in patients with good compliance can be treated.
There is some external callus formation present white arrow. Nail dynamization for delayed union and nonunion in femur and tibia fractures. The patients with intact or united fibula, preserved sensation in the sole, and adequate vascularity, were managed by tibialization medialization of the fibula huntingtons procedure, to restore continuity of. They may result in significant morbidity, require numerous operative procedures to treat, and leave the patient with functional deficits. This work is a prospective study comprising of 40 cases of diaphyseal nonunion of long bones including patients of age group 2152 years of both sexes. Different modalities of management like extensive debridement and local soft tissue flaps, using antibiotic beads, cancellous bone grafts, allografts vascular fibular grafts have been in use for decades. Nonunion and malunion hospital for special surgery.
Such radical debridement results in bone and soft tissue defects making the challenge more difficult with creation of a dead space. Nonunion is when the bone does not heal properly leaving the limb with pain and instability. Effect of lowintensity pulsed ultrasound treatment for. Can tibial nonunion be predicted at 3 months after. The objective of this clinical study was to improve the treatment outcomes in patients with a highly active infection by the three strategies consisting of a twostaged operation, a flowthrough technique for vascular anastomosis of a free vascularized fibular graft fvfg, and continuous local intraarterial. The treatment of septic nonunion of the tibia is a challenging area. Several different surgical treatment options have been proposed, including bone grafting 6, free tissue transfer 7.
Inclusion criteria were nonunion of the tibia associated with osteoporosis, in the diaphyseal area or distal third of the tibia with a small distal fragment. Local turn around flaps and microvascular free flaps may be needed for. Distraction of hypertrophic nonunion of tibia with. In children, the growth plate can sustain damage that results in limb deformity and shortening. Gap nonunion of tibia treated by huntingtons procedure. Exclusion criteria were nonunion of tibia with good bone stock, active infection, or large bony defects necessitating vascularized fibular graft or bone transport. Infection, infection severity score, tibia, nonunion. Infected nonunion of tibia and femur treated by bone. All patients were treated with a reamed intramedullary tibial nail. Prominence of the nonunion site was noted on the anteromedial surface of the tibia. Patients were assessed using the association for the study and application of the method of ilizarov criteria. Lyritsis e 1995 use of the ilizarov technique for treatment of nonunion of the tibia associated with infection. Treatment of non union of tibial diaphyseal fractures has always.
After two surgical interventions, both complicated with implant failure after bone nonunion, the segmental bone loss was treated in our clinic using free. Pdf infected nonunions of tibia pose many challenges to the. Plating, nailing, external fixation, and fibular strut. Find tibia non union information, treatments for tibia non union and tibia non union symptoms. Introduction a conservative method of treating four delayed union stress fractures of the anterior midtibia is described, with an illustrative case history. Delayed union stress fractures of the anterior tibia. Between 2000 and 2008, 30 patients with diaphyseal nonunion of tibia were managed with this technique. Discussion this is a retrospective study of bone transport in the treatment of the largest number of patients with infected nonunion of tibia and femur at present.
The nonunion persisted and this was corrected in 1983 by excision of the united tibial segment and a free vascularised fibula transfer from the contralateral leg. Exclusion criteria were nonunion of tibia with good bone stock, active infection, or large bony defects necessitating. Analysis of causes and treatment modality in nonunion of long bones diaphyseal fractures abstract. Fibulaprotibia in plating tibial nonunions galal z. We present a complex case of a femoral shaft nonunion, which was initially treated in other service. Radiographs of the tibia showed a hypertrophic tibia nonunion with the following deformity of the proximal to midthird on the right tibia. Methods once diagnosed each of the patients was treated in a pneumatic lower leg brace with modified rest. Debridement technique and dead space management for. Vascularized tibial periosteal graft in complex cases of bone nonunion in children. Challenges and controversies in defining and classifying. Wide resection of infected tissues decreases the recurrence rate of infection in postosteomyelitis reconstruction. Definition us fda panel defined non union as when a minimum of 9 months has elapsed since injury with no visible healing progressive signs for 3 months. Despite the different options available, treatment of tibial nonunions still is challenging for.
We are aware that smoking increases free radical production and that a high yield of free radicals is produced when a bone fractures. Nine of the patients underwent ilizarov ring fixation without soft tissue and bony resection, as inadequate stability was the reason for nonunion. Outcomes of ilizarov ring fixation in recalcitrant. Pdf vascularized tibial periosteal graft in complex. Nonunion is a common complication following spiral fractures of the tibia. There is also nonunion of an associated fibular fracture. Free vascularized bone grafts were found to be very effective in segmental bone defect resulted after trauma or wide tumor resection. Nonunion of long bones is a significant consequence in treating fractures. Original article role of ilizarov ring fixator in infected. Maximum cases of nonunion were of tibia followed by femur, radiusulna and humerus table1. Pdf infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Nail dynamization for delayed union and nonunion in femur. Background infected nonunion of tibia and femur are common in clinical practice, however, the treatment of these diseases has still been a challenge for orthopaedic surgeons.
Muhammad shahiduzzaman head, department of orthopaedics and traumatology dhaka medical college hospital. She was operated for the tumor in the tibia and thereafter several times for controlling infection and getting the fracture to. We focussed on the incidence, risk factors, evaluation, and treatment modalities for fibular nonunions as evident in the current literature and propose a treatment algorithm. Read circular frames in the management of infected tibial nonunion.
Ilizarov ring fixator, non union tibia, infection, compression, distraction introduction in this era of modern sciences, due to industrialization and increased automobile accidents, there are. Tibia shaft fractures present a substantial burden on patients and the healthcare system. Tibial shaft fractures are often caused by highenergy trauma with severe concomitant softtissue injuries. Nonunions further worsen the burden of tibia shaft fractures and lead to additional healthcare interventions 9,18. Non union presenterdr ravi varma v n moderatordr ravi kiran jss medical college 2. The pathogenesis and treatment of delayed union and nonunion. Do smokers have greater risk of delayed and nonunion. The cost of nonunion in a tibia shaft fracture can be upwards of. Ilizarov methods can eradicate infection, compensate bone defects and promote the bone union through progressive bone histogenesis. Open tibial shaft fx with bone loss vs closed nondisplaced. Request pdf nonunion of the femur and tibia delayed union and nonunion of tibial and femoral shaft fractures are common orthopedic problems. The most frequently used classification systems currently are more than 30 years old and do not take new knowledge of biology and modern treatment modalities into account. Circular frames in the management of infected tibial non. Ilizarov ring fixator in the management of infected nonunions of tibia.
The aim of this study is to evaluate the effectiveness of the fibulaprotibia plating technique in managing difficult diaphyseal tibial nonunions. The present study showed that infected nonunion of tibia and femur treated by bone transport acquired satisfied results. Many approaches to prevent fracture nonunion have been proposed. Goals of treatment in infected nonunion tibia are to obtain solid bony union, eradication of infection with maximum functional use of extremity. Frontal radiograph of the distal tibia shows a smooth and sclerotic line at the fracture ends blue arrows in a patient 14 months after the original fracture, signs of nonunion. Tibial shaft fractures management and treatment options. This 41 year old lay presented to us in 2008 with nonunion of left proximal tibia since 2001. Road traffic accident was the leading cause of injury, followed by fall. Tibia case 6 presenting this 51 year old woman sustained a left open distal tibia fracture while. Kaarela2 1department of orthopaedic trauma, oulu university hospital, oulu, finland 2department of plastic surgery, oulu university hospital, oulu, finland c e r a m e n t c a s e o f t h e m o n t h c e r a m e n t c a s e o f t h e m o n t h. Many different methods of treating this problem have been described using either autograft or allograft1 2 and several studies on bone morphogenetic proteins bmps being used to encourage bone healing have been published. The treatment of open tibial fractures and of tibial non. The mean range age of the patients was 28 2432 years and all were involved in professional or amateur sports. The aim of this study was to discuss the treatment of infective nonunion of diaphyseal fractures with ilizarov external fixation.
Since the process of bone healing is quite variable, a nonunion may go on to heal without intervention in a very few cases. In general, if a nonunion is still evident at 6 months post injury it will remain unhealed without specific treatment, usually orthopedic surgery. Seven patients were treated with free tissue transfers for infection andor inadequate soft tissue coverage. Infected nonunion of tibia and femur treated by bone transport. Treatment of infective nonunion of diaphyseal fractures. A local flap was used in 2 patients and a free flap was used in one patient.
Pdf and epub downloads, according to the available data and. Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. The principles and the management of nonunions orthopaedic. Ilizarov ring fixator in the management of infected non. Fibulaprotibia in plating tibial nonunions springerlink. Infected nonunion of tibia and femur are common in clinical practice. Some coexisting problems usually complicate the nonunion including persistent infection, bone and soft tissue loss, limblength inequalities, deformity, and joint stiffness 1,2. The etiology of a fracture nonunion is multifactorial. Twelve of the implanted in the distal tibia went on to union.
The young patients 1550years had maximum incidence of nonunion. Gap nonunion that may occur following trauma or infection is a challenging problem to treat. Fibulaprotibia in plating tibial nonunions europe pmc. This was a pretty difficult situation for her as she was diagnosed as a case of multiple myeloma.