Composite Fixation of Proximal Tibial Nonunions: A Technical Trick
TAKE-HOME POINTS
- Treatment goals for a nonunion are bone union, re-establishment of (joint) stability, extremity alignment, and recovery of function.
- A nonunion of a tibia plateau fracture is often associated with poor soft tissues from previous surgeries and/or infections.
- Ideally a combination of minimal soft tissue damage and maximal stable fixation is used for salvage.
- There is a high risk of complications when using dual plating in these cases.
- A combination of an external fixator with limited internal fixation can be a good alternative.
ABSTRACT
Nonunion after a proximal tibia fracture is often associated with poor bone stock, (previous) infection, and compromised soft tissues. These conditions make revision internal fixation with double plating difficult. Combining a plate and contralateral 2-pin external fixator, coined composite fixation, can provide an alternative means of obtaining stability without further compromising soft tissues.
Three patients with a proximal tibia nonunion precluding standard internal fixation with double plating were treated with composite fixation. All 3 patients achieved union with deformity correction at a mean of 5.2 months (range, 5-5.5 months). The average range of motion (ROM) arc was 100° (range, 100°-115°) and postoperative ROM returned to pre-injury levels.
Composite fixation can be a helpful adjunct in the treatment of this challenging problem.
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