The Journal of Bone and Joint Surgery, Vol 74, Issue 9 1286-1297, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Indirect reduction and tension-band plating of tibial non-union with deformity
DL Helfet, JB Jupiter and S Gasser
Orthopaedic Trauma Service, Tampa General Hospital, Florida.
Thirty-three patients who had a maligned non-union of the tibial diaphysis
were treated by limited open exposure, indirect reduction with a femoral
distractor, tension-band plating, lag-screw fixation, and autogenous
bone-grafting. The time from the injury to treatment of the non-union
averaged twenty-nine months. Twenty-two of the fractures were originally
open and sixteen fractures had had a previous infection before treatment of
the non-union. The non-unions were classified as hypertrophic in eight
patients, oligotrophic in eighteen, and atrophic in seven. All had severe
deformity, or the nature or level of the non-union, or both, precluded
intramedullary nailing as a treatment option. All thirty-three non-unions
healed at an average of four months; the average length of follow-up was
nineteen months. The deformity was corrected, within acceptable limits, in
thirty-two of the patients. Full motion of the knee was achieved in
twenty-nine patients and of the ankle, in eighteen. Complications included
four instances of superficial skin breakdowns, one deep infection, and one
fracture of the plate. For non-unions of the tibial diaphysis with
deformity that are not amenable to intramedullary nailing, the techniques
of limited exposure, indirect reduction, tension-band plating, and
bone-grafting can yield excellent anatomical and functional results.
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