Treatment of Wide Gap Non-Unions in Lower Extremities

ABSTRACT

PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.