A Retrospective Clinical Study Of Tibial Nonunion Causes And Treatment

Objective:Currently there is no uniform standard treatment of tibial nonunion, the treatment effect is not satisfied. This paper through the tibial nonunion clinical data were collected retrospectively analyzed to explore the factors that influence the tibial nonunion and treatment standard, to further guide clinical work. Materials and Methods:In this retrospective study, from January 2008- after January 2015 in Affiliated Xijing Hospital, Fourth Military Medical University orthopedic trauma and admitted the system of follow-up 44 cases of traumatic tibial nonunion cases, including 36 males and female 8 cases; aged 17-61 years, mean 39 years; nonunion site: 9 cases of upper, middle in 20 cases, 15 cases in the following paragraph. Injury: Traffic accident in 20 cases, falls in 12 cases, eight cases of heavy injured, falls in 4 cases. Type of fracture: transverse 8 cases, 18 cases of oblique, comminuted 18 cases. According to AO classification: A 13 cases, B, 8 cases, C 23 cases. Open wounds in 30 cases, 14 cases of closed injury. Before admission fixation: the outer frame 22 cases, 17 cases of plate, intramedullary set in 5 cases. Infection in 18 cases, 26 cases of non-infected before admission procedure: 1 times in 30 cases, 8 cases twice, three times six cases; Surgical average number of times before: 1.38 times. Preoperative treatment time: 6-34 months, an average of 16.3 months. Related improve preoperative examination, depending on the type and condition of the soft tissue tibial nonunion, select the appropriate surgical plan, infective tibial nonunion give one or two of ARBX bone graft, postoperative intensive rehabilitation to guide patients, step by step functional exercises. Results:44 patients, all of the follow-up. Followed up for 8 months- 5 years, an average of 2 years and 3 months, total healing rate 88.63%(39/44), wherein the non-infected tibial nonunion healing rate of 92.30%(24/26), infective tibial nonunion healing rate was 83.3%(15/18). The average healing time was 18.9 months(6 months-30 months), limb knee, ankle function recovered satisfactorily. Non-infective tibial nonunion with plate fixation in 8 cases, including one case of postoperative wound bone joint RBX appear yellowish exudate up to 5 days, but no infection, after timely medication, the final stage ?wound healing. Different bone graft materials and different fixation methods for treating the results shown in Table 1. Non-infective tibial nonunion in 26 cases, 24 cases of healing, 2 cases not healed after the first surgery, two cases of final treatment results are as follows: intramedullary nail fixation in 1 case in the first 10 months after no fracture healing power of distal locking row again at 6 months after bone healing. 1 Exceptions to the frame fixed by the first 3 months after the review, see the fracture line significantly, no callus formation, again row plus adjustment + RBX graft treatment, 14 months after the bone healing. No two cases of healing as follows: 1 case of plate fixation callus review see a little after 6 months, the fracture line is clear, had fistula in 8 months after the original surgical incision, after 12 months of complete line again debridement, external fixation surgery, fracture has not healed now. Exception frame 1 is fixed by severe bone defect, again outside the frame line adjustment and autogenous iliac bone graft surgery, now 10 months after the second operation, the fracture has not healed. Infective tibial nonunion complete healing in 15 cases, 2 cases of infection control, now part of the healing, 1 case of recurrent infection, fracture did not heal.