Effect of decortications on union rate of tibial plating

Tibial fracture is the most common long bone fracture. Because of the superficial location of the tibia, surgery is usually required for the treatment of fractures to achieve union. The goal of this study was to evaluate the effect of decortication on the faster union of fractures treated with compression plates. In this clinical trial, conducted from 2009 to 2013, 42 patients were randomly assigned to the decortication (20 patients) and control (22 patients) groups. Follow-up was performed every 2 weeks until union was achieved, and then patients were examined after 6 and 9 months for analysis of final union. Mean time to weight bearing with 2 crutches, weight bearing with 1 crutch, weight bearing with a cane, and complete weight bearing without pain in the control group (receiving only the compression plate) was 5.59, 7.50, 9.32, and 11.05 weeks, respectively. Mean time to weight bearing with 2 crutches, weight bearing with 1 crutch, weight bearing with a cane, and complete weight bearing without pain in the decortication group was 4.90, 6.35, 7.75, and 9.25 weeks, respectively. All 4 values were significantly higher in the decortication group compared with the control group (P<.05). Erythema and signs of inflammation were significantly associated with decortication and were more common in the decortication group. No infection, broken plate, or nonunion occurred in either group. Because decortication had a significant effect on achieving union in nonunion fractures, it could be used to induce faster clinical union in acute tibial fractures.