Reosteosynthesis of the tibial shaft. Part II. Changement of procedure after plate osteosynthesis.
A series of 23 reosteosynthesis of the tibial shaft, primarily treated with a plate osteosynthesis, is presented. More than 60% of the fractures were open and more than 75% were of the type B or C of the AO-classification. In these fracture types, the apposition of the fracture fragments is incomplete (type B) or totally absent type (type C) after closed reduction. A pseudarthrosis was responsible for the reosteosynthesis in 65% of the patients and an implant failure in more than 40%. The second intervention was performed after an average time of 8.1 months. In 12 of the 23 patients a second plate osteosynthesis, in 7 patients an external fixation and in 4 an endomedullary nailing was carried out. The time between the second stabilization and the bone healing was 5.9 months. The functional end results were excellent or good in 70%. Fragment necrosis in comminuted fractures or after imprudent dissection of the fracture site leads to important bone healing disturbances after plate osteosynthesis. When a delayed union or developing pseudarthrosis can be suspected, a quick changement of procedure should be planned. A new plate osteosynthesis combined with a transplantation of cancellous bone seems to be the most appropriate procedure. In definite cases, an endomedullary nailing or external fixation is desirable.
Rommens
P M
PM
Department of Traumatology and Emergency Medicine, University Hospital of Leuven, Belgium.
Van Raemdonck
D E
DE
Broos
P L
PL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011542:Pseudarthrosis / Q000601:surgery; D013978:Tibial Fractures / Q000601:surgery*