Treatment Of Tibial Nonunion: Minimally Invasive Percutaneous Plate Osteosynthesis Technology Combined With New "Olive" Autologous Bone Grafting

Objective:Nonunion has become a major problem in orthopedics, and tibialnonunion is relatively common. Some factors, like high energy trauma,infection, and iatrogenic factors (excessive periosteal stripping, bloodsupply destruction, lack of soft tissue protection) can cause tibialnonunion. Patients with tibial nonunion have many problems: somerequire repeated surgeries, and muscle atrophy in the lower leg is acommon problem. Many patients completely lose confidence, becomingdiscouraged and depressed. Conventional open reduction and internalfixation can result in many complications. For example, skin necrosis,soft tissue infections, and nonunion or delayed bony unions have beenreported. We retrospectively analyzed18cases treated with MIPPOtechnology combined with new “olive” autologous bone grafting andevaluated the fracture healing and limb function of patients.Method:This was a retrospective study. From2010to2013, the radiographsand clinical notes for all18male patients with nonunion of the tibiatreated with MIPPO technology combined with olive autologous bonegrafting from the iliac crest and the autologous cancellous grafts wereplaced into the bony defects. The average patient age was41years (range,24–57years). The mean follow-up time was10months (range,3–23 months). All fractures were caused by high-speed injuries, includingmotor vehicle accidents (motorcycle or car) and falls from height. Thepatients were initially treated with external or internal fixation, but tibialnonunion occurred6months later, making re-operation inevitable.Each case of nonunion was classified by its location in the tibia:proximal (four patients), middle (four patients), distal (nine patients), ormiddle and distal (one patient) thirds of the tibia. Ten patients sustainedmultiple fractures, including femoral fracture and comminuted tibiofibulafracture. One patient had a nerve injury, one patient had a vascular injury,and six patients had open fractures of the tibia and fibula. Anterolateralplates were used in11cases, medial plates were used in6cases, andanterolateral and medial plates were used in one case.Results:Radiographic evaluations were performed at1month,3months,6months, and1year until radiological healing occurred. None of thepatients had limb pain, deformities, fixation failure, infection, vascular ornerve injuries, or skin necrosis. Functional results were graded asexcellent in14cases and good in four cases. There was no need forre-operation. The average operation and fluoroscopy times for the tibianonunion were75min (range,60–85min) and20s (range,10–30s),respectively. Radiologically confirmed bony healing with totalconsolidation of the graft was achieved in all patients in an average of13 weeks (range,4–24weeks). The cases were followed up for3–23months.No apparently related osteonecrosis of the bone was observed during thefollow-up period, and the total blood loss was80–130ml.Conclusion:The innovative application of MIPPO technology combined with anew olive autologous bone grafting method for the treatment of tibialnonunion can preserve bone blood supply, promote fracture healing, Thesuccess rate of this technology is high, During follow-up, none of ourpatients had limb pain, deformities, fixation failure, infection, vascular ornerve injuries, or skin necrosis, which preliminarily proved that thismethod is a safe and effective treatment for tibial nonunion.