title: Mechanobiology in the management of mobile atrophic and oligotrophic tibial nonunions.
abstract: BACKGROUND
  Recent research indicates that atrophic nonunions are biologically active and may heal in the optimal biomechanical environment.
  
  
  METHODS
  Thirty-three patients with mobile atrophic and oligotrophic tibial nonunions were treated with circular external fixation and functional rehabilitation. Seven patients required autogenous bone graft procedures.
  
  
  RESULTS
  Bony union was achieved after the initial surgery in 31/33 (93.9%) tibias. Two persistent nonunions were successfully treated with repeat circular external fixation without bone graft. This resulted in final bony union in 33/33 (100%) patients.
  
  
  CONCLUSIONS
  Mechanobiological stimulation of tibial nonunions can produce union even if the biological activity appears to be low.
authors.affiliation: Tumour Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 3201, South Africa.
authors.forename: Nando
authors.initials: N
authors.lastname: Ferreira
authors.affiliation: Tumour Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 3201, South Africa.
authors.forename: Leonard Charles
authors.initials: LC
authors.lastname: Marais
authors.affiliation: Medical Research Scientist, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, 4051, South Africa.
authors.forename: Colleen
authors.initials: C
authors.lastname: Aldous
keywords: Atrophic; Circular external fixator; Ilizarov; Nonunion; TrueLok