Salvage fixation of proximal tibia non-union and mal-union with 95° angled blade plates

Abstract

Introduction: Proximal tibia non-unions and mal-unions can present particular challenges in their management because of a short proximal segment, excessive misalignment and soft tissue compromise. Available options in the management should consider the biomechanical demand of that anatomical location. The aim of this study was to determine the long-term functional outcomes of patients treated with open reduction and internal fixation with 95° angled blade plate (ABP). Materials and methods: Total of twenty nine patients with a proximal tibial non-union and mal-unions were retrospectively treated between September 2016 and March 2022. Eighteen (62%) were non-unions, and eleven (38%) were mal-unions. The male were 21 (72%) and female were 8 (18%); Right tibia in 16 patients, and left tibia in 13 patients. Among the non-unions twelve were originally closed fractures, and six were open fractures. While among the eleven mal-unions, Eight were varus deformity and three were valgus deformity. All cases were treated with a consistent approach of debridement, deformity correction, angled blade plate fixation, and with or without bone grafting. Only 5 patients who presented with non-union had bone graft. Results: All the twenty nine patients’ fixations healed within an average of 30 weeks, and alignment was within 5° of anatomic in all cases after follow up for a median 3.2 years (range 1.8 to 6.6). The average duration of union after surgery was 4.5 month (range 3 to 7.5 month). The outcome were 23 (79%) excellent; 4 (14%) good; 1 (3.5%) fair, and 1 (3.5%) poor result based clinical and radiological evaluations of pain, range of knee motion, limb length, fracture healing and overall satisfaction with daily living activities. Conclusions: For clinical and biomechanical consideration, 95° ABP could be a very suitable implant in the management of metaphyseal non-union and mal-unions of the proximal tibia with high success rate.