title: Does inter-tibiofibular graft still have a role in the treatment of lower-limb non-union?
abstract: BACKGROUND
  Tibial non-union is a complication that poses a real challenge for surgeons. Several forms of treatment, depending on the type of non-union, have been described. The present study sought to assess results for treatment of tibial non-union by inter-tibiofibular graft (ITFG).
  
  
  METHODS
  An exhaustive cohort study was performed on the files of 33 patients: 25 male, 8 female; mean age, 44years. Twenty cases involved high-energy trauma. Twenty-four were open fractures. Twenty-two concerned diaphyseal fracture, 10 of which were complex segmental. Eleven concerned distal fracture, including 4 complete articular fractures. There were 17 cases of septic non-union. There were no cases of severe bone defect. ITFG was performed at a mean 8.7 months post-trauma, as first-line treatment in 30 cases and in second line in 3.
  
  
  RESULTS
  Thirty-one patients showed bone consolidation, at a mean 7.2 months. The 2 failures resulted from technical error. Trauma kinetics emerged as a risk factor for failure.
  
  
  CONCLUSIONS
  ITFG remains a useful treatment option in tibial non-union, whether infected or not. The present results are comparable with those of the literature. Although the present series comprised only tight non-union, a study of the literature showed that ITFG can treat bone defects up to 4 or 5cm. Functional results showed tibiotalar joint stiffening, due more to immobilization and non-weight-bearing than to syndesmosis. ITFG thus remains relevant to the treatment of tibial non-union.
  
  
  METHODS
  IV, retrospective study.
authors.affiliation: CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens, France. Electronic address: linda.ferraz@hotmail.fr.
authors.forename: L
authors.initials: L
authors.lastname: Ferraz
authors.affiliation: CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: M
authors.initials: M
authors.lastname: Juvet-Segarra
authors.affiliation: CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: X
authors.initials: X
authors.lastname: Pocquet
authors.affiliation: CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: P
authors.initials: P
authors.lastname: Mertl
authors.affiliation: CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: E
authors.initials: E
authors.lastname: Havet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D016267:External Fixators; D005260:Female; D005360:Fibula / Q000293:injuries* / Q000601:surgery; D005592:Fracture Fixation; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D055815:Young Adult
keywords: Bone graft; External fixator; Non-union; Tibial fracture