ABSTRACT
BACKGROUND:Nonunion is a common clinical problem in the prognosis of tibial fracture. The treatment method of tibial fracture nonunion is extensive and develops rapidly. Different repair plans should be taken to the nonunion of tibial fractures caused by different factors. OBJECTIVE:To summarize the repair strategy and effect of adjuvant therapy of internal fixation implants and external fixation stent for treatment of tibial fracture nonunion. METHODS:The PubMed database and CNKI database were retrieved by the author of this article for the published articles related to reason and treatment method of nonunion. The key words were “tibial fracture nonunion, reason,treatment, implant, external fixation”. The repetitive and old articles were eliminated. RESULTS AND CONCLUSION:(1) Finaly 35 articles were selected for further analysis. (2) Surgical method is the chief treatment for tibial fracture nonunion. We choosedifferent surgical methods for the best curative effect according to the reasons of nonunion and whether it is infected or not. The biological and structural factors that cause bone delayed healing should be considered in the treatment. (3) The fixed treatment on the structure is divided into external fixation and internal fixation. Intramedulary nail and compression plate can give stability of nonunion without infected tibial fractures, and it is a good solution to the structural problems. External fixation can be used for nonunion of infected tibial fracture. (4) To solve the biological problems of nonunion of tibial fractures (bone defect), various bone grafting materials and bone grafting techniques can be used. It is generaly required to fix the bonegraft in the treatment of nonunion of the tibia fracture. In recent years, biological materials have been gradualy applied to solve the problem of bone nonunion of tibial fractures. Although electrical stimulation and ultrasound have been shown to promote fracture healing, it has not been clinicaly proven to be used in the treatment of nonunion of tibial fractures.
ABSTRACT
Objective To analyze the causes for the failures after posterior pedicle screw instrumentation for thoracolumbar fractures.Methods From June 2003 to December 2014,182 patients with thoracolumbar fracture were treated by fixation through the posterior approach using pedicle screws and fully followed up in our institute.We analyzed the cases of postoperative infection,recovery of neural symptoms,breakage and loosening of pedicle screws and connecting rod,non-union of the fractured vertebra,and correction loss of kyphosis in associations with the AO classification and Loading Sharing Classification of Spine Fracture (LSCSF) system,osteoporosis,intervertebral disc injury and methods of internal fixation.Results In this series,altogether 27 cases failed(14.8％).The rate of postoperative infection was 1.1％ (2/182).The rate of breakage of pedicle screw or connecting rod was 7.7％ (14/182).The implant breakage rates for fractures of AO types A1,A2 and A3.1 were significantly lower than for other types (P ＜ 0.05).The implant breakage rate for the patients with ≤6 LSCSF points was significantly lower than for those with ≥7 LSCSF points (P ＜ 0.05).The implant breakage occurred in 3 cases of those who underwent fixation of one normal vertebra respectively below and above the two contiguous segments but not in those who underwent additional fixation of the injured vertebrae.The rate of screw loosening was 2.2％ (4/182).The non-union rate of the injured vertebra was 2.7％ (5/182).The rate of kyphosis recurrence was 1.1％ (2/182).Conclusions To prevent the failure of posterior pedicle screw fixation,surgeons should pay more attention to the following key points before operation:the type and evaluation of spinal fractures,a proper approach and method of internal fixation,and the weight bearing capability of the anterior column.