One stage intervention for infected, non-united, short tibia

ABSTRACT

Post-traumatic tibial non-union in association with infection is a real surgical problem. When tibial shortening occurs and soft tissue [especially skin] complications are added to this problem due to multiple surgical procedures to solve the first problem, this is one of the heaviest complications in bone-joint surgery. Twenty five tibial non-united fractures; [8-65y],complicated with infection shortening [4-9 cm.] and skin or other soft tissue complications; following repeated surgeries [2-5 previous operations] were subjected to debridement of the soft tissues at the non-union site with excision of bone ends till healthy bone [adding more shortening]. Mono-planer external fixators were applied to all cases; compression was applied to fracture site, and distraction-callotasis principle was performed at a proximal [or distal] corticotomy. Bone healing was achieved in 24 cases [96%] in 12 - 28 weeks [mean of 18.2 weeks]. Infection was eradicated in 22 cases [88%]; all were united. The mean length gained was 7.7 cm [6 to 12.5 cm]. Satisfactory results were obtained in 22 patients [88%] and unsatisfactory results in 3 patients [12%].No major complications were encountered; There have been no refractures or loss of length, after a follow-up of 2.3 years [range 2 - 4 y] mono-planer devices when applied properly and combined with proper debridement can give a high success rate in achieving bone healing, eradication of infection and correction of shortening in tibial non-union associated with infection and shortening