Posttraumatic nonunion of the proximal tibial metaphysis

Eighteen patients with nonunions of the proximal tibial metaphysis were treated at one institution. Nine patients had a history of osteomyelitis. There was an average of 4 prior surgical procedures to achieve fracture union, obtain soft-tissue coverage, or eradicate infection. Stable internal fixation with bone grafting was performed in 13 patients, with a fixed angle blade plate in 10 and standard compression plate in 3. Three patients were treated with hybrid circular external fixators, and one patient was placed in a cast. An additional patient underwent long-stem total knee arthroplasty with structural allografting. Follow-up averaged 45 months. Osseous union was achieved in 100% of patients. Alignment was within 5 degrees of neutral in 94% of patients. Forty-four percent of patients continue to require the assistance of a cane for ambulation. Twelve patients have some pain with activity, primarily related to ipsilateral knee arthrosis. No infections have recurred. Knee motion improved an average of 28 degrees. Healing of nonunions of the proximal tibial metaphysis may be achieved with meticulous soft-tissue care and appropriate stabilization of small, osteoporotic, periarticular fragments.