Bijukachhe Binod1, Singh Nagmani2, Bhandari Bigyan1, John Rakesh3, Adhikari Prashant1. 1. Department of Orthopedics, Grande International Hospital, Kathmandu, Nepal. 2. Department of Orthopedics, Grande International Hospital, Kathmandu, Nepal. vayu_79@yahoo.com. 3. Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
INTRODUCTION: Tibial nonunion is the most common nonunion encountered by the orthopedic surgeon. Repeated surgeries, cost, increased duration of hospital stay, disability, pain all contribute to the increased morbidity. Many methods have been used to treat nonunion of tibia with variable results and none of them are 100 % successful. Our objective was to determine the effectiveness of modification of Judet's decortication technique and buttress plating, without bone graft, in the treatment of aseptic, atrophic tibial nonunion. Also, to find the correlation between time of achieving union and time since injury to decortication. MATERIALS AND METHODS: Ours is a retrospective study conducted at a Level I trauma center. A total of 35 cases of atrophic tibial nonunion, irrespective of the cause, was treated by modifying Judet's osteoperiosteal decortication and plating during the time period January 2006 to July 2013. Demographic data, range of motion, time of achieving union and clinico-radiological evaluation for union of fracture were included as main outcome measurements. RESULTS: Union was achieved in all cases with a mean duration of 8.34 months. Pain and stiffness of joints were not reported in any case on long-term follow-up and the patients had satisfactory range of motion. Implant removal was done in three cases after fracture union. CONCLUSION: Treatment of atrophic tibial nonunion is challenging and management of each nonunion has to be customized based on the biological and mechanical characteristics of the nonunion. Plating with osteoperiosteal decortication is an effective and simple technique, which in our hands has shown to result in 100 % union rates without the need of additional bone healing augmentation procedures like bone grafting. LEVEL OF EVIDENCE: Level II.
INTRODUCTION: Tibial nonunion is the most common nonunion encountered by the orthopedic surgeon. Repeated surgeries, cost, increased duration of hospital stay, disability, pain all contribute to the increased morbidity. Many methods have been used to treat nonunion of tibia with variable results and none of them are 100 % successful. Our objective was to determine the effectiveness of modification of Judet's decortication technique and buttress plating, without bone graft, in the treatment of aseptic, atrophic tibial nonunion. Also, to find the correlation between time of achieving union and time since injury to decortication. MATERIALS AND METHODS: Ours is a retrospective study conducted at a Level I trauma center. A total of 35 cases of atrophic tibial nonunion, irrespective of the cause, was treated by modifying Judet's osteoperiosteal decortication and plating during the time period January 2006 to July 2013. Demographic data, range of motion, time of achieving union and clinico-radiological evaluation for union of fracture were included as main outcome measurements. RESULTS: Union was achieved in all cases with a mean duration of 8.34 months. Pain and stiffness of joints were not reported in any case on long-term follow-up and the patients had satisfactory range of motion. Implant removal was done in three cases after fracture union. CONCLUSION: Treatment of atrophic tibial nonunion is challenging and management of each nonunion has to be customized based on the biological and mechanical characteristics of the nonunion. Plating with osteoperiosteal decortication is an effective and simple technique, which in our hands has shown to result in 100 % union rates without the need of additional bone healing augmentation procedures like bone grafting. LEVEL OF EVIDENCE: Level II.
Authors: Hunter Pelham; Donald Benza; Paul W Millhouse; Nathan Carrington; Md Arifuzzaman; Caleb J Behrend; Jeffrey N Anker; John D DesJardins Journal: Sci Rep Date: 2017-05-04 Impact factor: 4.379
Authors: Łukasz Szelerski; Sławomir Żarek; Radosław Górski; Karol Mochocki; Ryszard Górski; Piotr Morasiewicz; Paweł Małdyk Journal: J Orthop Surg Res Date: 2020-05-19 Impact factor: 2.359