Eli A Swanson1, Eli C Garrard, Daniel P OʼConnor, Mark R Brinker. 1. *Department of Orthopaedic Trauma, University of Texas Health Science Center at Houston, Houston, TX; †Department of Health and Human Performance, University of Houston, Houston, TX; and ‡Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX.
Abstract
OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion. DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Forty-six aseptic tibial nonunion sites in 40 patients (2 bilateral and 4 segmental) who presented with an intramedullary nail on an average of 16 months after the initial treatment were presented in this study. INTERVENTION: Insertion of an exchange nail of at least >2-mm diameter than the prior nail using a different manufacturer's nail, static interlocking, partial fibulectomy in a select group of patients, and correction of underlying metabolic and endocrine abnormalities. MAIN OUTCOME MEASUREMENTS: Union rate, time to union. RESULTS: Forty-five of 46 tibial nonunion sites (98%) healed at an average of 4.8 months. CONCLUSIONS: Patient selection criteria and a systematic approach to exchange nailing for tibial nonunion is highly successful. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion. DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Forty-six aseptic tibial nonunion sites in 40 patients (2 bilateral and 4 segmental) who presented with an intramedullary nail on an average of 16 months after the initial treatment were presented in this study. INTERVENTION: Insertion of an exchange nail of at least >2-mm diameter than the prior nail using a different manufacturer's nail, static interlocking, partial fibulectomy in a select group of patients, and correction of underlying metabolic and endocrine abnormalities. MAIN OUTCOME MEASUREMENTS: Union rate, time to union. RESULTS: Forty-five of 46 tibial nonunion sites (98%) healed at an average of 4.8 months. CONCLUSIONS:Patient selection criteria and a systematic approach to exchange nailing for tibial nonunion is highly successful. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: Christian Hierholzer; Jan Friederichs; Claudio Glowalla; Alexander Woltmann; Volker Bühren; Christian von Rüden Journal: Int Orthop Date: 2016-10-28 Impact factor: 3.075
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