Journal List > J Korean Fract Soc > v.21(4) > 1037660

Kim, Shon, Lee, Kim, Lee, Kang, Wang, and Ha: Cause and Treatment of Extraarticular Proximal Tibial Nonunion

Abstract

Purpose

To analyze the factors affecting the nonunion of extraarticular proximal tibial fracture and the outcome of nonunion treatment.

Materials and Methods

We investigated 51 cases of extraarticular proximal tibial fractures from June 2002 to May 2006. The nonunion rate was assessed in relation to several risk factors and the treatment outcome of nonunion using plate fixation with bone graft was assessed by Klemm and Börner functional rating system.

Results

6 cases of nonunion (11.8%) was noted among 51 cases, and the risk factors examined, OTA A3 comminuted fracture was associated with a high nonunion rate with statistical significance and initial bone graft had a significant effect in bone healing. Excellent and good results were obtained in 5 cases (83.3%) and bone union was achieved in all nonunion cases.

Conclusion

Comminution was found to be an important factor affecting the nonunion in extraarticular proximal tibial fracture, and bone graft in primary operation could reduce the chance of nonunion. Accurate plate fixation with bone graft is a reliable option in nonunion treatment.

Figures and Tables

Fig. 1

A 27-year-old male involved in a incar traffic accident suffered a closed comminuted (OTA A3) proximal tibial fracture.

(A) Plain radiographs after application of hybrid type external fixator with autoiliac bone graft.
(B) Plain radiographs shows bone union at postoperative 9 months.
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Fig. 2

(A) A 55-year-old male involved in a pedestrian traffic accident suffered a open comminuted (G-A Grade II, OTA A3) proximal tibial fracture.

(B) Wound debridement and hybrid type external fixator was performed.
(C) Postoperative 8 months, plate fixation with autoiliac bone graft was performed for proximal tibial nonunion.
(D) Bone union was achieved at 7 months after second operation with satisfactory functional result.
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Table 1

Functional results of the nonunion patients by Klemm and Börner classification

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Table 2

Data analysis of proximal tibial nonunion patients

jkfs-21-279-i002

*TA: Traffic accident, OTA: Orthopedic Trauma Association, C: Closed fracture, §O: Open fracture.

Table 3

Statistic analysis of nonunion rate related to risk factors

jkfs-21-279-i003

*TA: Traffic accident, OTA: Orthopedic Trauma Association.

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