Journal of Orthopedics and Joint Surgery

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  6 (2024)
Volume  5 (2023)
Volume  4 (2022)
Volume  3 (2021)
Volume  2 (2020)
Volume  1 (2019)
Related articles

VOLUME 5 , ISSUE 1 ( January-June, 2023 ) > List of Articles

Original Article

A Study on Factors Influencing Nonunion Tibia with Failed Fixation and Its Management Outcome

S Vijaya Anand, Rex Chandrabose, Prem Anand

Keywords : Factors causing nonunion tibia, Nonunion tibia, Refixation for nonunion tibia, Surgical factors influencing nonunion tibia, Treatment-dependent factors

Citation Information : Anand SV, Chandrabose R, Anand P. A Study on Factors Influencing Nonunion Tibia with Failed Fixation and Its Management Outcome. 2023; 5 (1):12-15.

DOI: 10.5005/jp-journals-10079-1109

License: CC BY-NC 4.0

Published Online: 03-01-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: Nonunion tibia is not uncommon due to various deleterious factors. We came across a significant number of cases of nonunion owing to fallacy in primary treatment modalities. This study is to analyze and identify the preventable causes of nonunion and their outcomes after our treatment with refixation and bone grafting. Materials and methods: It is a retrospective study of 53 patients of failed fixation resulting in nonunion tibia treated in our center between June 2018 and May 2020. All patients were treated with internal fixation and bone grafting after implant removal. The surgery was done by a single surgeon for all patients with inclusion and exclusion criteria excluding open fractures. Results: All 53 cases of nonunion united at 3 months. As per the functional outcomes concerned using short form (SF-36) score, we found 52 cases had excellent outcomes and three had late infection necessitating implant removal. We could delineate certain preventable reasons for nonunion from this study, mostly due to treatment modalities. Conclusion: We conclude that certain technical factors play a major role in nonunion, which could be easily averted by paying meticulous attention to surgical techniques and details.

HTML PDF Share
  1. Mills LA, Aitken SA, Simpson AHRW. The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults. Acta Orthop 2017;88(4):434–439. DOI: 10.1080/17453674.2017.1321351
  2. Bishop JA, Palanca AA, Bellino MJ, et al. Assessment of compromised fracture healing. J Am Acad Orthop Surg 2012;20(5):273–282. DOI: 10.5435/JAAOS-20-05-273
  3. Rodriguez-Merchan EC, Forriol F. Nonunion: general principles and experimental data. Clin Orthop Relat Res 2004;419(419):4–12. DOI: 10.1097/00003086-200402000-00003
  4. Panagiotis M. Classification of non-union. Injury 2005;36(4):S30–S37. DOI: 10.1016/j.injury.2005.10.008
  5. Bungaro P, Pascarella R, Colozza A, et al. Rigid fixation with plate and bone graft in failures of intramedullary osteosynthesis for the treatment of diaphyseal nonunion of the femur. Chir Organi Mov 1999;84(3):263–267. PMID: 11569041.
  6. Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury 2007;38(2):S19–S22. DOI: 10.1016/s0020-1383(07)80005-2
  7. Gelalis ID, Politis AN, Arnaoutoglou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury 2012;43(7):980–988. DOI: 10.1016/j.injury.2011.06.030
  8. Fong K, Truong V, Foote CJ, et al. Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study. BMC Musculoskelet Disord 2013;14(1):103. DOI: 10.1186/1471-2474-14-103
  9. Drosos GI, Bishay M, Karnezis IA, et al. Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures. J Bone Joint Surg Br 2006;88(2):227–231. DOI: 10.1302/0301-620X.88B2.16456
  10. Murray IR, Foster CJ, Eros A, et al. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am 2013;95(13):1153–1158. DOI: 10.2106/JBJS.K.01275
  11. Niikura T, Lee SY, Sakai Y, et al. Causative factors of fracture nonunion: the proportions of mechanical, biological, patient-dependent, and patient-independent factors. J Orthop Sci 2014;19(1):120–124. DOI: 10.1007/s00776-013-0472-4
  12. Duckworth AD, Bennet SJ, Aderinto J, et al. Fixation of intracapsular fractures of the femoral neck in young patients: risk factors for failure. J Bone Joint Surg Br 2011;93(6):811–816. DOI: 10.1302/0301-620X.93B6.26432
  13. Day SM, DeHeer DH. Reversal of the detrimental effects of chronic protein malnutrition on long bone fracture healing. J Orthop Trauma 2001;15(1):47–53. DOI: 10.1097/00005131-200101000-00009
  14. Bosch U, Skutek M, Kasperczyk WJ, et al. Diaphysäre oberarmpseudarthrosen - operative und konservative behandlung [Nonunion of the humeral diaphysis - operative and nonoperative treatment]. Chirurg 1999;70(11):1202–1208. DOI: 10.1007/s001040050771
  15. Ueng SW, Wei FC, Shih CH. Management of femoral diaphyseal infected nonunion with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting. J Trauma 1999;46(1):97–103. DOI: 10.1097/00005373-199901000-00016
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.