Tips

Composite Fixation of Proximal Tibial Nonunions: A Technical Trick

Publish date: September 27, 2018

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.

References

1. Wu CC. Salvage of proximal tibial malunion or nonunion with the use of angled blade plate. Arch Orthop Trauma Surg. 2006;126(2):82-87. doi:10.1007/s00402-006-0106-9.

2. Carpenter CA, Jupiter JB. Blade plate reconstruction of metaphyseal nonunion of the tibia. Clin Orthop Relat Res. 1996;332:23-28.

3. Gardner MJ, Toro-Arbelaez JB, Hansen M, Boraiah S, Lorich DG, Helfet DL. Surgical treatment and outcomes of extraarticular proximal tibial nonunions. Arch Orthop Trauma Surg. 2008;128(8):833-839. doi:10.1007/s00402-007-0383-y.

4. Toro-Arbelaez JB, Gardner MJ, Shindle MK, Cabas JM, Lorich DG, Helfet DL. Open reduction and internal fixation of intraarticular tibial plateau nonunions. Injury. 2007;38(3):378-383. doi:10.1016/j.injury.2006.11.003.

5. Mechrefe AP, Koh EY, Trafton PG, DiGiovanni CW. Tibial nonunion. Foot Ankle Clin. 2006;11(1):1-18, vii. doi:10.1016/j.fcl.2005.12.003.

6. Chin KR, Nagarkatti DG, Miranda MA, Santoro VM, Baumgaertner MR, Jupiter JB. Salvage of distal tibia metaphyseal nonunions with the 90 degrees cannulated blade plate. Clin Orthop Relat Res. 2003;(409):241-249.

7. Devgan A, Kamboj P, Gupta V, Magu NK, Rohilla R. Pseudoarthrosis of medial tibial plateau fracture-role of alignment procedure. Chin J Traumatol. 2013;16(2):118-121. doi:10.3760/cma.j.issn.1008-1275.2013.02.011.

8. Helfet DL, Jupiter JB, Gasser S. Indirect reduction and tension-band plating of tibial non-union with deformity. J Bone Joint Surg Am. 1992;74(9):1286-1297.

9. Bolhofner BR. Indirect reduction and composite fixation of extraarticular proximal tibial fractures. Clin Orthop Relat Res. 1995;(315):75-83. doi:10.1097/00003086-199506000-00009.

10. Ries MD, Meinhard BP. Medial external fixation with lateral plate internal fixation in metaphyseal tibia fractures. A report of eight cases associated with severe soft-tissue injury. Clin Orthop Relat Res. 1988;(256):215-223.

11. Weiner LS, Kelley M, Yang E, et al. The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures. J Orthop Trauma. 1995;9(3):244-250.

12. Alghadir A, Anwer S, Brismee JM. The reliability and minimal detectable change of Timed Up and Go test in individuals with grade 1-3 knee osteoarthritis. BMC Musculoskelet Disord. 2015;16:174. doi:10.1186/s12891-015-0637-8.

13. Haverkamp D, Sierevelt IN, Breugem SJ, Lohuis K, Blankevoort L, van Dijk CN. Translation and validation of the Dutch version of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2006;34(10):1680-1684. doi:10.1177/0363546506288854.

14. Ahlbäck S. Osteoartrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh). 1968;Suppl 277:7-72.

References

1. Wu CC. Salvage of proximal tibial malunion or nonunion with the use of angled blade plate. Arch Orthop Trauma Surg. 2006;126(2):82-87. doi:10.1007/s00402-006-0106-9.

2. Carpenter CA, Jupiter JB. Blade plate reconstruction of metaphyseal nonunion of the tibia. Clin Orthop Relat Res. 1996;332:23-28.

5. Mechrefe AP, Koh EY, Trafton PG, DiGiovanni CW. Tibial nonunion. Foot Ankle Clin. 2006;11(1):1-18, vii. doi:10.1016/j.fcl.2005.12.003.

8. Helfet DL, Jupiter JB, Gasser S. Indirect reduction and tension-band plating of tibial non-union with deformity. J Bone Joint Surg Am. 1992;74(9):1286-1297.

9. Bolhofner BR. Indirect reduction and composite fixation of extraarticular proximal tibial fractures. Clin Orthop Relat Res. 1995;(315):75-83. doi:10.1097/00003086-199506000-00009.

11. Weiner LS, Kelley M, Yang E, et al. The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures. J Orthop Trauma. 1995;9(3):244-250.

14. Ahlbäck S. Osteoartrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh). 1968;Suppl 277:7-72.

Mycobacterium abscessus: A Rare Cause of Periprosthetic Knee Joint Infection

Composite Fixation of Proximal Tibial Nonunions: A Technical Trick

TAKE-HOME POINTS

References

ABSTRACT

Pages

Next Article: