title: Surgical treatment and outcomes of extraarticular proximal tibial nonunions.
abstract: BACKGROUND
  Although malunion of proximal tibial metaphyseal fractures are not infrequent, nonunion of the proximal tibia is rare. These nonunions can present particular challenges in management, such as malalignment, a short proximal segment, and soft tissue compromise. Few treatment guidelines and long-term outcomes are available. The purpose of this study was to determine the long-term functional outcomes of patients treated with open reduction and internal fixation.
  
  
  METHODS
  Sixteen patients with a proximal tibial nonunion were treated between 1992 and 2005. Five fractures were originally open injuries, but all were aseptic at the time of definitive fixation. All nonunions were treated with a consistent approach of debridement, deformity correction, lateral plating, tensioning and compression, lag screws and bone grafting. Patients were reviewed radiographically and with a Knee Society questionnaire at a mean follow-up of 39 months (range 10-113 months).
  
  
  RESULTS
  All nonunions healed at an average of 4 months, and alignment was within 5 degrees of anatomic in all cases. Knee Society function and knee scores improved significantly, to 87.4 and 89.4, respectively (P < 0.05 for both). Functional outcomes were excellent overall. Fourteen of the patients (88%) subjectively returned to their previous activities and were satisfied with their result.
  
  
  CONCLUSIONS
  Using an algorithmic approach of débridement, deformity correction, lateral tension band plating with compression, and rigid stabilization, fracture healing and functional outcome can be reliably restored in these difficult fractures.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. gardnerm@hss.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
authors.forename: Jose B
authors.initials: JB
authors.lastname: Toro-Arbelaez
authors.forename: Mathias
authors.initials: M
authors.lastname: Hansen
authors.forename: Sreevathsa
authors.initials: S
authors.lastname: Boraiah
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
authors.forename: David L
authors.initials: DL
authors.lastname: Helfet
mesh_terms: D000328:Adult; D003646:Debridement; D005260:Female; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome