The objective of this study was to evaluate the clinical and radiological results of the treatment of aseptic nonunion of the tibia by plating and bone grafting.This retrospective study included 40 patients with aseptic nonunion of the tibia, treated in the Trauma-Orthopedic department B4 of CHU Hassan II in Fez-Morocco. The average age was 41 years (range 25-60 years). The initial fractures were in the middle third of the tibia for the majority of our patients. We used the ASAMI criteria to assess the results.We found 45 patients with aseptic nonunion of the tibia who were treated by the same surgical team and followed in postoperative consultation for a fixed period of 10 months. Three patients lost to follow-up and two patients refused the treatment. In 37 patients (92.5%), union was obtained after a mean delay of 4.3 months (range 3-7 months). The average time from initial treatment to treatment for nonunion was eight months (range 6-10 months). According to the ASAMI classification, bone results were excellent in 26, good in 8, fair in 3 and poor in 3; functional results were excellent in 10, good in 16, fair in 11 and poor in 3.Our study suggests that the combination of screwed plate and autograft in the treatment of aseptic nonunion of the tibia has provided satisfactory results. A well-codified management of the initial fracture remains the gold key to prevent the occurrence of pseudarthrosis. 

/pdf/aseptic-nonunion-of-the-tibia-treated-by-plating-and-bone-20zt92dw.pdf

Aseptic nonunion of the tibia treated by plating and bone grafting: retrospective study about 40 cases

BACKGROUND Established tibial nonunions rarely heal without secondary intervention; revision surgery is the most common intervention. Herein, we evaluated the clinical outcomes of patients with tibial nonunion treated with a new technique - minimally invasive percutaneous plate osteosynthesis (MIPPO) - combined with a new onionskin-like autologous bone grafting method. MATERIAL AND METHODS From 2010 to 2013, 18 patients with tibial nonunions (average bone defect: 9.5 mm) were treated with MIPPO technology combined with onionskin-like autologous bone grafting. Indices for clinical evaluation included operative time, ﬂuoroscopy time, blood loss, hospital stay, healing time, postoperative complaints, radiographic performances, the Short Musculoskeletal Function Assessment (SMFA) questionnaire, and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. RESULTS The average operation and ﬂuoroscopy times for tibial nonunion were 65 min and 15.5 s, respectively, with a total blood loss of 107.7 mL. The mean duration of hospital stay was 12.8 days. The mean follow-up time was 11.9 months, and all patients achieved radiologically confirmed bony healing in an average time of 13.1 weeks. No lower-leg deformity, fixation failure, infection, and vascular, or nerve injuries were recorded in any patient, and only 4 patients complained of slight limb pain upon total weight-bearing at the end of follow-up. The SMFA and AOFAS ankle-hindfoot scores of patients were graded excellent in 14 (77.8%) and good in 4 (22.2%), indicating high functional recovery. CONCLUSIONS MIPPO technology combined with onionskin bone grafting is an efficient method to treat patients with tibial nonunion, especially for patients with poor soft tissue condition.

/pdf/minimally-invasive-percutaneous-plate-osteosynthesis-mippo-1n3zotfmzb.pdf

Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) Combined with Onionskin-Like Autologous Bone Grafting: A New Technique for Treatment of Tibial Nonunion.

Background The aim of this study was to assess the clinical and radiological results of the dome-shaped high tibial osteotomy (HTO) which was fixed with a novel construct comprised of semi-circular Ilizarov frames and pins. Methods The patients with at least five years of follow-up were evaluated. One-hundred and thirty-two knees of 114 patients were included in the final analysis. The clinical evaluation included range of motion and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Anatomical femorotibial angle (aFTA), anatomical medial proximal tibial angle (aMPTA), tibial slope and Insall–Salvati ratio were calculated on standard weight-bearing radiographs. Results The average aFTA was improved from 1.6° varus to 8.7° valgus (P  Conclusions The semi-circular Ilizarov pin construct provided satisfactory outcomes both clinically and radiologically at mid- to long-term follow-up.

Dome-shaped high tibial osteotomy with semi-circular Ilizarov pin fixator: Mid- to long-term results of a novel technique.

Background: the diaphyseal fractures of the tibia are frequent entities that usually affect young patients Those located in the distal third of the tibia have peculiarities due to their anatomical location and vascularization Objective: to update the most distinctive elements of the diaphyseal fractures of the distal third of the tibia and the therapeutic confrontation Methods: the information search and analysis was performed over a period of four months (April 1st, 2019 to June 30th, 2019) and the following words were used: distal third tibial fracture, fractures of the distal tibia, diaphyseal tibial fractures Based on the information obtained, a bibliographic review of a total of 563 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search manager and EndNote reference manager, of which 37 citations selected were used to carry out the review, of them 33 of the last five years and 11 books were consulted Results: the anatomical edges of the distal third of the tibia are mentioned Both conservative and surgical treatment methods are described with special emphasis on intramedullary fixation and placement technique Reference is made to other fixing methods such as external fixation, plates and screws with specific indications To conclude, the delay in consolidation and pseudoarthrosis is addressed through the use of morphogenetic bone protein Conclusions: fractures of the distal third of the tibia need the expertise of the medical staff to reduce complications related to the anatomical characteristics of the area and biomechanics of the trauma DeCS: TIBIAL FRACTURES/complications; TIBIAL FRACTURES/therapy; TIBIAL FRACTURES/surgery; FRACTURE FIXATION, INTRAMEDULLARY; ORTHOPEDIC PROCEDURES

/pdf/fracturas-diafisarias-del-tercio-distal-de-la-tibia-3bye72ep8s.pdf

Fracturas diafisarias del tercio distal de la tibia

The purpose of this study was to assess a population of patients with nonunion of the tibia treated with the Ilizarov method in terms of achieved union rates and maintained union rates, determination of re-fracture factors, with a subsequent comparison of our findings with those reported in the available literature. This study was a retrospective assessment of 102 patients with nonunion of the tibia treated with the Ilizarov method in the period 2008–2015. The assessed parameters were bone union achieved during treatment, duration of stabilization with an Ilizarov external fixator, and maintained bone union at the last follow-up visit. The mean age at the start of treatment was 46.7 years (11–84 years). The mean follow-up period was 7 years (2–12 years). Bone union was achieved in all patients. The mean duration of Ilizarov stabilization in the study group was 7.9 months (2.8–20.7 months). The rate of union maintained at the last follow-up visit was 95.1%. All patients in our study achieved bone union, which constitutes a better outcome than those reported on average in the literature (73.7–100%). The mean length of time which the Ilizarov external fixator was in place in our patients was 8.3 months, which is consistent with the data from literature. Infection, atrophic nonunion, nonunion in 1/3 distal of tibia, and close surgery technique are risk factors of re-fracture. None of the analyzed studies assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.

/pdf/a-new-criterion-for-assessing-ilizarov-treatment-outcomes-in-2rybacdgo0.pdf

A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia.

Objective To evaluate the healing rate of aseptic nonunions of the distal third of the tibia treated with Ilizarov slow gradual compression and deformity correction. Design Retrospective cohort study. Setting Tertiary referral center. Patients/participants Ninety-four consecutive adult patients with 94 distal third tibial aseptic nonunions. Intervention Ilizarov external fixation and slow gradual compression; most patients also underwent bone grafting, deformity correction, or both before the initiation of compression. Main outcome measurements Rate of bony union. Results Eighty-seven of 94 cases (92.6%) healed after slow gradual compression across the nonunion site with a circular external fixator. Four of the 7 patients who failed treatment healed after additional operative treatment, and the remaining 3 refused further care. Conclusions Circular external fixation with slow gradual compression was successful in treating aseptic nonunions of the distal third of the tibia in 92.6% of cases. Careful selection of patients for this treatment method can lead to a high success rate with a relatively low rate of major complications. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

High Rate of Union for Aseptic Distal Tibial Nonunions in Adults Treated With Slow Gradual Compression via Circular External Fixation.

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High Rate of Union for Aseptic Distal Tibial Nonunions in Adults Treated With Slow Gradual Compression via Circular External Fixation.