Distal tibial hypertrophic nonunion with deformity: treatment by fixator-assisted acute deformity correction and LCP fixation

Abstract

Distal tibial hypertrophic nonunion with angular deformity has been successfully treated by circular external fixator. The inconvenience of the bulky external fixator and frequent pin tract infection would not be accepted in certain cases. This study included thirteen patients (mean age 39 years) with angular deformity of the distal dia-/metaphyseal tibial shaft. Five patients were originally treated by interlocking nail, three were treated by plate and screws fixation, four treated conservatively and one had deformity secondary to fracture of a lengthening regenerate. All patients were treated by osteotomy and acute correction of the deformity using temporary unilateral fixator and internal fixation by a locking compression plate (LCP). The external fixator was removed at the end of surgery. The results were evaluated both clinically and radiologically. All osteotomies healed within 3 (2–4) months. All patients were able to work within an average of 2.3 months. The function of the upper ankle joint was unrestricted in twelve cases, and in 1 case there was a mild functional deficit. The mean follow-up was 60 months (24–120). The frontal plane alignment parameters (the mechanical axis deviation, the lateral distal tibial angle and the medial proximal tibial angle) and the sagittal alignment parameters (the posterior proximal tibial angle and the anterior distal tibial angle) were within normal values postoperatively. No cases of deep infection or failure of fixation were encountered. Acute correction of distal tibial shaft hypertrophic nonunion with deformity and LCP fixation is a reliable option in well-selected cases.

Fixator-assisted Technique Enables Less Invasive Plate Osteosynthesis in Medial Opening-wedge High Tibial Osteotomy: A Novel Technique

“…We believe the proximal half pin, which is inserted deeply up to 1 cm medial to the lateral tibial cortex, can help prevent accidental fracture of the lateral tibial plateau when applying valgus force. The fixator-assisted technique showed advantages in controlling alignment in fracture and/or deformity correction surgeries [6][7][8]22]. Our study showed that this fixatorassisted technique achieved accurate target correction in the coronal plane while maintaining posterior tibial slope in the sagittal plane.…”

Biocompatible Porous Tantalum Metal Plates in the Treatment of Tibial Fracture

“…Currently, the compression locking plate (LCP) is a common surgical technique for the treatment of malunion and nonunion of tibial fractures. El‐Rosasy et al showed that tibial fractures with angulation deformity less than 35° and limb length difference less than 2.4 cm after correction could be treated with internal fixation and compression locking plates; using this method resulted in few complications and, therefore, it proved an ideal internal fixation technique for promoting bone healing. However, the drawbacks of LCP are that it cannot provide adequate stability and that it is associated with poor postoperative treatment for patients with large bone defects and nonunion, resulting in further malunion or even nonunion of fractures.…”

“…Based on different injury mechanisms, the nonunion and malunion of tibial fractures can be categorized into hypertrophic, malnutrition, atrophy, infection and synovial pseudoarticular formation. In recent years, researchers worldwide have extensively studied the mechanism and treatment of different types of nonunion and have developed various new ideas and methods, but the primary concern is still the local stability and maintenance of proper blood supply. Although various surgical treatment and repair methods of nonunion and malunion of tibial fractures have been rapidly developed, the optimal treatment solution for these fractures remains controversial.…”

Management of hypertrophic nonunion with failure of internal fixation by distraction osteogenesis

“…However, the tissue at the region of hypertrophic nonunion is a reservoir of mesenchymal progenitor cells, which can subsequently differentiate into cartilageor bone-forming cells [1], as well as fibrocartilaginous tissue that is capable of osteogenesis once the mechanical instabilities are corrected by establishing a stable osteosynthesis construct [4,5]. Several methods have been described for the correction of facture nonunion, including plate osteosynthesis [6], intramedullary (IM) nailing [7], bone grafting, and external fixation [8,9]. However, these methods have some disadvantages, including complex plating technique, the need for extensive soft-tissue dissection, breakage of plate or screw, and screw loosening [8,10].…”