Risk Factors of Nonunion Demanding Surgical Treatment after Lumbar Posterolateral Fusion

STUDY DESIGN: This is a retrospective study for radiographically and clinically assessing nonunion after lumbar spine fusion. OBJECTIVES: We wanted to analyze the risk factors for nonunion that requires surgical treatment after lumbar spine fusion SUMMARY OF THE LITERATURE REVIEW: A diagnosis of the nonunion after lumbar spine fusion was made by using only the only radiologic images. The incidence of nonunion has been underreported because there are many asymptomatic patients. MATERIALS AND METHODS: The plain X-ray films were evaluated for 1317 patients who could be followed up more than 1 year after lumbar fusion. Nonunion was diagnosed at 1 year after fusion by instability seen on the flexion-extension radiograph and the clinical findings like as sustained pain and local tenderness at the surgical site. The risk factors we reviewed included age, the number of levels fused, associated diseases, smoking, alcohol drinking, the initial diagnosis, a previous history of spinal operation, infection, a clear zone and malposition of pedicle screws and metal failure. The relations between nonunion and the factors mentioned above were analyzed. RESULTS: Thirty-nine patients were diagnosed as having nonunion underwent reoperation and all had surgically confirmed nonunion. Smoking, infection and a previous history of spine operation had a significant influence on nonunion (p < 0.05). Clear zones persisting more than 1 year and metal failure also had a significant influence on nonunion (p < 0.05). Age, the number of fused levels, the initial diagnosis and alcohol drinking were not shown to influence the rate of nonunion (p < 0.05). CONCLUSION: A through clinical and radiologic evaluation is essential to diagnose nonunion, and this should not be done according to the radiologic images only. Risk factors such as a previous history of spine operation, infection, smoking, the development of a clear zone and metal failure all showed a statistically significant influence on nonunion. Additionally, preoperative and postoperative evaluation of these parameters is needed to achieve bone union.

Cause and Treatment of Extraarticular Proximal Tibial Nonunion

PURPOSE: To analyze the factors affecting the nonunion of extraarticular proximal tibial fracture and the outcome of nonunion treatment. MATERIALS AND METHODS: We investigated 51 cases of extraarticular proximal tibial fractures from June 2002 to May 2006. The nonunion rate was assessed in relation to several risk factors and the treatment outcome of nonunion using plate fixation with bone graft was assessed by Klemm and BOrner functional rating system. RESULTS: 6 cases of nonunion (11.8%) was noted among 51 cases, and the risk factors examined, OTA A3 comminuted fracture was associated with a high nonunion rate with statistical significance and initial bone graft had a significant effect in bone healing. Excellent and good results were obtained in 5 cases (83.3%) and bone union was achieved in all nonunion cases. CONCLUSION: Comminution was found to be an important factor affecting the nonunion in extraarticular proximal tibial fracture, and bone graft in primary operation could reduce the chance of nonunion. Accurate plate fixation with bone graft is a reliable option in nonunion treatment.

Arthroscopic Internal Fixation of Displaced Tibial EminenceFracture Using Cannulated Screw / 대한정형외과학회잡지

PURPOSE: This study examined the outcome of arthroscopic internal fixation for types II and III tibial eminence fractures in children using a cannulated screw. MATERIALS AND METHODS: A series of 10 cases of displaced fractures of tibial eminence of the tibia that were treated with an arthroscopic cannulated screw fixation from February, 1997 to October, 2005 were examined. Four patients had a type II and six patients had a type III tibial eminence fracture according to the Meyer and McKeever's classification. All the patients were reviewed radiographically and clinically for bone union, instability and the range of motion after an average follow-up of 22.4 months (range, 12 to 81 months). RESULTS: There were no cases of nonunion. The clinical examination showed that, all the patients with types II and III lesions had a negative Lachman test, and a full range of motion with the exception of one patient with a type III fracture. The average Lysholm functional score was 96.3 (mim 92.6-max 99.0) for all types II and III lesions. CONCLUSION: Arthroscopic internal fixation with a cannulated screw for types II and III avulsion fractures of the tibial eminence in children can provide a satisfactory outcome through firm fixation of the fragment and an early start of the range of motion.