The “Road to Union” protocol for the reconstruction of isolated complex high-energy tibial trauma

Abstract

Level IV; case series.

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

“…Limb salvage is often associated with a high rate of complications [18,22]. The overall complication rate in this series was 40%, similar to the rate of complications reported previously [9,14,15,31,32].…”

“…Limb salvage using a hexapod external fixation system without ankle fusion remains a very attractive surgical option for distal tibial nonunions. Early soft-tissue management, restoration of limb length, deformity correction, and the ability to weight-bear promote functional recovery [22]. However, typical treatment times are long and complications are frequent [15], and patients should be informed about the expected time in frame and the associated high complication rate.…”

“…All patients had their implants removed and treatment followed a standardized protocol, described previously [22]. Briefly, this treatment protocol includes eight defined steps:…”

Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects

“…Infected tibial non-unions have always been extremely difficult to manage successfully, and this challenge is magnified when a segment of bone is absent [1][2][3][4][5][6] . Chronic osteomyelitis may require additional resection of necrotic bone to eradicate an active nidus of infection [7,8].…”

Current concepts in the management of open tibia fractures

“…Similarly, Hohmann et al reported good outcomes using a staged 'Road to Union' protocol in their management of complex and acute complex tibial fractures. 108 A modification of this technique, which is well described by multiple authors, is the intentional shortening and/or deformation of the limb to achieve bony apposition as well soft tissue closure, decreasing or negating the need for soft tissue flaps. 48,104,105,109,110 The length and/or deformity is then gradually corrected utilising either conventional Ilizarov external fixation or hexapod external fixation.…”