[Orthotopic tibiofibular fusion: indications--technique--results]

Between 1988 and 1992, 54 patients with complicated tibial non-union were treated by tibio-fibular fusion. In 6 cases of comminuted fracture the operation was performed within the first 2 months, especially in the case of distal fractures. Fifteen patients suffered from aseptic tibial pseudarthrosis, and further 6 from an additional defect. In 25 patients treatment for infected non-union was needed and in 3 cases tibio-fibular synostosis was induced after segmental transport and non-docking. Most of the patients had conspicuous soft tissue lesions, and 14 required transplantation of a regional or free flap. So far 46 patients have completed their treatment. In 44 cases full weight-bearing on the affected leg is possible. In 2 cases the treatment failed. None of our patients required limb amputation at the site of synostosis. In 13 cases the follow-up showed clearly that the axis was not right, in 11 cases a varus deformity. Most of these deviations have not been corrected because of poor quality of the soft tissue coverage. We suggest this method be used as part of a technique allowing the fibula to stay in its original position while providing tibio-fibular fusion by interposition of autologous cancellous bone grafting and transfixing screws. Additional stabilization might be achieved by using an external fixator, for preference. Partial weight-bearing is allowed after 2 weeks and full weight-bearing is attained on average after 3-4 months. Concerning the initial lesion, the primary aim of the treatment should be the recovery of full weight-bearing without an additional device and without chronic infection.(ABSTRACT TRUNCATED AT 250 WORDS)