The Journal of Bone and Joint Surgery, Vol 74, Issue 9 1279-1285, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Compression plating for non-union after failed external fixation of open tibial fractures
DA Wiss, DL Johnson and M Miao
Los Angeles County, University of Southern California Medical Center.
Fifty non-unions of the tibia that were present in forty-nine patients
after external fixation and immobilization in a cast for a high-energy
fracture were subsequently treated by compression plating. Initially, there
were forty-six open fractures and four closed fractures with a compartment
syndrome. Twenty-two non-unions (44 per cent) had early soft-tissue
reconstruction (thirteen rotational and nine free flaps). The duration of
external fixation averaged ten weeks, and the mean time from injury to
plating was eight months. None of the non-unions were infected at the time
of plating. The average preoperative deformity in the sagittal
(anterior-posterior) plane was 8 degrees and in the frontal
(medial-lateral) plane, 9 degrees; after plate fixation, the residual
angulation averaged 3 and 2 degrees. Autogenous bone graft was used in
thirty-nine of the fifty non-unions. The patients were followed for an
average of twenty-four months. Forty-six (92 per cent) of the non-unions
united, in an average of seven months, without further intervention. In
four patients (8 per cent), the plate broke, necessitating re-plating in
three and external fixation in one (the latter patient had an infected
non-union). A deep infection developed in three patients (6 per cent).
Ultimately, forty-eight non-unions (96 per cent) healed without evidence of
infection. Plate osteosynthesis is an effective method of treatment for
patients who have had an open fracture of the tibia that has failed to
unite after external fixation and immobilization in a cast.
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