Treatment of tibial nonunion with posterolateral bone grafting |
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Institution: | 1. Department of Biomedical Engineering, Yonsei University, Wonju, Gangwon-Do, 26493, Republic of Korea;2. Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine, Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea;1. Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany;2. Department of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany;3. \"Fracture Committee\" of the German Knee Society, Germany;1. Interuniversity Centre for Health Economics Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium;2. Medical Registration, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium;3. Emergency and Disaster Medicine, Department Emergency Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium;4. Mobility, Logistics and Automotive Technology Research Centre, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussel, Belgium;5. Interuniversity Centre for Health Economics Research, Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium |
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Abstract: | ObjectivesPosterolateral bone grafting to treat nonunions of the distal two-thirds of the tibia avoids the often traumatized and more tenuous anterior soft-tissue envelope. Few modern reports of its effectiveness are available. We assessed whether posterolateral bone grafting leads to high union and low complication rates.MethodsWe conducted a retrospective review at a Level I trauma center. Our study group was 59 patients with distal two-thirds tibial fractures treated with posterolateral bone grafting. Patients included those with history of deep surgical site infection (SSI) before bone grafting (n = 17), established nonunions (n = 42), and impending nonunions associated with open fractures and bone gaps (n = 17). All patients were followed for a minimum of 12 months unless they achieved union before that time point. Our primary outcome measurement was fracture union. Secondary outcome measurements were any complication associated with the approach and infection requiring return to the operating room.ResultsFracture union was achieved in 44 (75%) of 59 patients without further intervention. The mean interval to union was 9.9 months (range, 3–22). Of 11 infected nonunions treated, nine progressed to union. Seventeen of 23 patients with defects >2 cm, including defects up to 5.4 cm without infection, were successfully treated. Two patients who underwent grafting at least 10 years after initial injury achieved union. No complications were associated with the approach (specifically, no wound breakdown, vascular injury, or tendon injury). Fourteen percent of patients experienced SSI after bone grafting. Seven of eight deep SSI occurred in patients with previous infection or positive intraoperative cultures. Only one (3%) of 36 patients without infection pre- or intraoperatively experienced SSI.ConclusionsEven in this relatively difficult patient cohort that included large bone gaps and history of infection, union was achieved at a relatively high rate with posterolateral bone graft. The approach seems to be safe, considering no known complications specifically associated with the approach occurred, and seems to reduce the risk of SSI in the absence of previous infection. |
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Keywords: | Tibial fracture Tibial nonunion Posterolateral bone graft Surgical site infection |
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