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Infected tibial nonunion
G H Shahcheraghi1, A Bayatpoor
1Department of Orthopedics, Shiraz University of Medical Sciences, Iran.
Objective:
To compare three methods of surgical treatment for infected nonunion of tibial fractures.
Design:
Chart review.
Setting:
Two teaching hospitals of Shiraz University Medical School in Iran.
Patients:
Fifty-eight patients with infected nonunion of tibial fractures treated between 1976 and 1989. All patients had received antibiotic therapy before treatment for nonunion.
Interventions:
Bone grafting with cast immobilization (group 1), bone grafting with insertion of compression plates (group 2) and bone grafting with intramedullary rod fixation (group 3).
Main Outcome Measures:
A clinical scoring system based on functional ability, range of knee and ankle motion, shortening, infection and pain.
Results:
After the first operation union was achieved in 75% of group 1 patients, 84% of group 2 and 100% of group 3; 41% of patients had excellent or good results and 47% had fair or poor results. Twelve percent of patients had nonunion (failure). Union in fractures treated with intramedullary rod fixation (group 3) occurred faster, and patients in this group had a higher number of good or excellent results than those in the other groups. Treatment without fixation (group 1) resulted in fair or poor results in over 50% of cases.
Conclusion:
In terms of union and function, the best surgical treatment for infected nonunion of tibial fractures in this series was bone grafting and intramedullary rod fixation, after adequate débridement and antibiotic therapy.