A Comparative Study Of Operation On Tibial Nonunion

Background and purpose:Tibial fracture is a common disease of osteology,about 10% of fracture of long bone.The more important is the high morbility of open fracture,the tibial nonunion maybe caused by open fracture of tibia.The treatment of tibial nonunion including non-operative method which including functional recovery,electronic stimulus,physical or chemical therapy etc;operative method which including BMP transport , fibular osteotomy, plate fixation,intramedullary nailing,conventional external fixation,small wire external fixation.This research including two different methods of tibial nonunion using internal bone transport or intramedully nailing,and then compare the postoperative recovery,healing index of fracture,the comply of patient in order to observe the clinical result of different treatment.Method:1. Includnig standard(l)Over half year of healing since fracture and the formation of pseudojoint (2)Over half year of healing since fracture,appearance of fracture line, (3)Clinical founding of infection,deformanity,purulence of sinus,shortness of leg.2. Assemble the data:(1)Between January 2003 and December 2005 data were respectively obtained on our 16 consective cases of internal bone transport. 12 cases of open fracture(3 cases of IIIA type,7 cases of IIIB type,2 cases of IIIC type),4 cases of postoperative infection(all of plate fixation). 10 cases of exposure of bone orplate fixation,8 x 4cm defect of soft tissue as the largest.We gathered the detailed operation method,healing index,condition of function recovery ,condition of patients'comply.(2)Between January 2003 and December 2005 data were respectively obtained on our 9 consective cases of intramedullary nailing.9 cases of closed fracture(2 cases of plate fixation,7 cases of intramedullary nailing).6 cases of atrophic tibial nonunion,3 cases of hypertrophic tibial nonunion. 3.Data analyzing:We evaluated the role of the internal bone transport in contrast to theintramedullary nailing by compare the healing index,condition of functionrecovery,morbility of incoming syndrome.Result:All 16 cases of infected tibial nonunion were interviewed for 12 months for average(6-21 month).All cases no infection,no sinus formation,no abscess.The average Healing Index is 46 d/cm.The most common symptom is infection of pin site. 10 cases of 21 pin site infection.All 9 cases of aseptic tibial nonunion were interviewed for 9 month(5-12 month).l cases of atrophic tibial nonunion received internal bone transport.Conclusion:Our research shows that internal bone transport using mono-lateral external fixation has big advantage in contral infection .Internal bone transport using mono-lateral external fixation can given long bone defect for infected tibial nonunion.Intramudellary nailing has big advantage in aseptic tibial nonunion.