Use of reamed locked intramedullary nailing in the treatment of aseptic diaphyseal tibial non-union.
BACKGROUND
Tibial fractures have been associated with the highest rates of bone union disturbances for many years. Stabilization of the tibial shaft with a reamed intramedullary nail is now being increasingly recommended as a treatment of choice. The aim of this study was to evaluate the outcomes of treatment of tibial shaft non-union with reamed intramedullary nails locked distally and proximally.


METHODS
Thirty-three patients (11 females and 22 males) with tibial shaft non-union were treated by locked intramedullary nailing. There were twelve patients with a biologically active non-union, while in the remaining 21 the non-union was biologically non-active. The diagnosis was based on case history, physical examination and X-ray data. The average non-union time was 26.96. An intramedullary nail was inserted according to the technique recommended by AO/ASIF. Follow-up examinations were performed at six-week intervals until bone union was obtained. The diagnosis of bone union was based on physical examination and X-ray evidence. The functional outcome was assessed according to the Johner-Wruhs scale. Treatment failure was defined as the absence of clinical and radiological signs of bone union 12 months after surgery.


RESULTS
Bone union was achieved in 94% patients following an average time of 37.2 weeks. The functional outcome was classified as good or very good according to the Johner and Wruhs scale in 60% of the patients, while 18% of the patients were diagnosed to have a poor functional outcome. An infection of the non-union site was found in 6 patients, of whom two developed a chronic infection (in one patient bone union was not achieved).


CONCLUSIONS
The treatment of an aseptic non-union of the tibial shaft with an intramedullary nail is an effective procedure. This conclusion must be regarded as tentative in view of the small sample size.
Niedźwiedzki
Łukasz
Ł
Klinika Ortopedii i Traumatologii, Instytut Fizjoterapii, Collegium Medicum, Uniwersytet Jagielloński, Poland. lniedzwiedz@cm-uj.krakow.pl
D000328:Adult; D000368:Aged; D001858:Bone Nails; D018483:Diaphyses / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome