Atrophic, aseptic, tibial nonunion: how effective is modified Judet's osteoperiosteal decortication technique and buttress plating?
BACKGROUND
Tibial nonunion is the most common nonunion encountered by the orthopedic surgeon. Repeated surgeries, cost, increased duration of hospital stay, disability, pain all contribute to the increased morbidity. Many methods have been used to treat nonunion of tibia with variable results and none of them are 100 % successful. Our objective was to determine the effectiveness of modification of Judet's decortication technique and buttress plating, without bone graft, in the treatment of aseptic, atrophic tibial nonunion. Also, to find the correlation between time of achieving union and time since injury to decortication.


METHODS
Ours is a retrospective study conducted at a Level I trauma center. A total of 35 cases of atrophic tibial nonunion, irrespective of the cause, was treated by modifying Judet's osteoperiosteal decortication and plating during the time period January 2006 to July 2013. Demographic data, range of motion, time of achieving union and clinico-radiological evaluation for union of fracture were included as main outcome measurements.


RESULTS
Union was achieved in all cases with a mean duration of 8.34 months. Pain and stiffness of joints were not reported in any case on long-term follow-up and the patients had satisfactory range of motion. Implant removal was done in three cases after fracture union.


CONCLUSIONS
Treatment of atrophic tibial nonunion is challenging and management of each nonunion has to be customized based on the biological and mechanical characteristics of the nonunion. Plating with osteoperiosteal decortication is an effective and simple technique, which in our hands has shown to result in 100 % union rates without the need of additional bone healing augmentation procedures like bone grafting.


METHODS
Level II.
Department of Orthopedics, Grande International Hospital, Kathmandu, Nepal.
Bijukachhe
B
Binod
Department of Orthopedics, Grande International Hospital, Kathmandu, Nepal. vayu_79@yahoo.com.
Singh
S
Nagmani
Department of Orthopedics, Grande International Hospital, Kathmandu, Nepal.
Bhandari
B
Bigyan
Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
John
J
Rakesh
Department of Orthopedics, Grande International Hospital, Kathmandu, Nepal.
Adhikari
A
Prashant
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D000071538:Cortical Bone / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D055815:Young Adult
Aseptic; Atrophic; Judet’s; Nonunion; Plating; Tibia