Internal fixation of aseptic non-united fractures of tibia after implant failure by interlocking nail and bone grafting

ABSTRACT

This study was performed to evaluate the results of internal fixation of non-united fractures of the tibia by interlocking nailing after implant failure. Fourteen patients were included in the study, 10 males and 4 females who were admitted to the Suez Canal university hospital. The average age was 36 years [21-68]. Patients who had non-united fracture tibia after implant failure were the material of this work. Eleven patients had been treated with plate and screws and three by locked intra-medullary nailing. Twelve patients had closed fractures and two had open fractures Gastilo I. The diagnosis of nonunion was made on the absence of progression of the radiological signs of union and the persistence of pain at the fracture site. The mean interval between fracture and secondary surgery was 13 months [6 to 21]. Open technique was used in all patients for removal of tibial plating and Locked intra-medullary nailing and also laying down an iliac bone graft at the non-united fracture Site. Clinical union was proved in all patients with pain-free weight-bearing and this precede radiological union which occurs in all patients after 3 to 9 months with an average of 4 months. Angular and rotational deformities were corrected in all patients and 4 patients had shortening of 1 to 2.5 cm. One patient developed infection but debridement and frequent dressing and antibiotics resulted in relieve of infection after one month and union occurred radiologically after 9 months. Locked nailing, providing stable fixation, with iliac bone graft in patients with aseptic nonunion of the tibia allows physiologic early weight bearing stresses at the fracture site, together with the osteogenic potential of the bone graft, stimulate healing of the nonunion