Intramedullary nailing in the treatment of aseptic tibial nonunion

Citation
P. Megas et al., Intramedullary nailing in the treatment of aseptic tibial nonunion, INJURY, 32(3), 2001, pp. 233-239
Citations number
26
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
ISSN journal
00201383 → ACNP
Volume
32
Issue
3
Year of publication
2001
Pages
233 - 239
Database
ISI
SICI code
0020-1383(200104)32:3<233:INITTO>2.0.ZU;2-P
Abstract
Fifty patients suffering from aseptic tibial nonunion underwent reamed intr amedullary nailing (I.N.) and were retrospectively reviewed. Thirty-six pat ients were initially treated with external fixation, six with plate and scr ews, one with a static I.N., and seven with plaster of Paris. Eighteen of t he fractures were initially open (A: 5, B: 6, and C: 7 according to the Gus tilo classification). In 34 cases a closed procedure was performed, whereas in sixteen, an opening at the nonunion site was unavoidable either to remo ve metalwork or realign the fragments. Following failed external fixation, secondary I.N. was performed at least 10 days after removal of the device. Bone grafts from the iliac crest were used in three cases, and a fibular os teotomy was performed in 33. Patients were followed up for an average of 2. 5 years after nailing, ranging from 10 months to 7 years. A solid union was achieved in all patients within a period of 6 months. One patient develope d late infection, which settled after nail removal and one patient develope d impending compartment syndrome which was detected on the first post-opera tive day and was treated with a fasciotomy. Transient peroneal nerve palsy occurred in one patient and this recovered in 3 months, whereas in nine pat ients a clinically acceptable deformity was noticed. In conclusion, we beli eve that reamed intramedullary nailing is a highly effective treatment for aseptic tibial nonunions. Early and late complications are rare and bone gr aft is rarely needed. The method allows early weight bearing even before so lid union occurs, short hospitalisation time and early return to work witho ut external support. (C) 2001 Elsevier Science Ltd. All rights reserved.