Metwaly Radwan G, Younis Ahmed Saeed
Ain-Shams University, Cairo, Egypt.
Ain-Shams University, Cairo, Egypt.
Injury. 2023 Nov;54(11):111057. doi: 10.1016/j.injury.2023.111057. Epub 2023 Sep 22.
The objective of this study was to assess the efficacy of augmentation plating with retaining of previous implant in situ in cases of non-united oligotrophic or atrophic aseptic distal tibial diaphyseal and metaphyseal fractures without bone grafting depending on the unified bone healing and non-union theory.
Through the period between December 2019 and December 2022, twelve patients with distal third tibial non-unions who were fixed at time of fracture either by intramedullary interlocking nails (seven cases) or by minimally invasive plate osteosynthesis (five cases) were included. Non-union was diagnosed on basis of absence of any healing progression in three months period or absence of fracture healing after six months from index surgery. All patients had oligotrophic or atrophic non-union. Augmentation plating through an anterolateral approach was done on average of 7.25 months after initial surgery (6-9 months). Circumferential exposure of the fracture site and debridement of fibrous tissue were not necessary. No bone grafting was done as no cases had major bone defect.
All patients achieved complete radiological union with a mean time of 21.8 weeks (range 18-30 weeks) that mean full callus formation in all cortices. All patients were walking independently after three months (13weeks) from surgery and returned to work even in cases of absent complete radiological union. No cases had been complicated with wound healing problems (infection or dehiscence). One patient had incomplete ankle dorsiflexion (10°) due to tight calf muscles and one patient had paresthesia on the dorsum of the foot that was not improved at last follow up (one year after surgery).
Augmentation plating is a safe and effective option for management of distal tibial diaphyseal nonunion even in cases of oligotrophic or atrophic non-union.
本研究的目的是根据统一的骨愈合和骨不连理论，评估在不进行植骨的情况下，原位保留先前植入物的增强钢板固定术治疗胫骨远端干骺端和骨干营养不良性或萎缩性无菌性骨不连的疗效。
纳入2019年12月至2022年12月期间12例胫骨远端三分之一骨不连患者，这些患者在骨折时分别采用髓内交锁钉固定（7例）或微创钢板接骨术固定（5例）。根据术后三个月内无任何愈合进展或初次手术后六个月仍未骨折愈合来诊断骨不连。所有患者均为营养不良性或萎缩性骨不连。初次手术后平均7.25个月（6 - 9个月）通过前外侧入路进行增强钢板固定。无需对骨折部位进行环形暴露和纤维组织清创。由于所有病例均无大的骨缺损，因此未进行植骨。
所有患者均实现了完全放射学愈合，平均时间为21.8周（范围18 - 30周），即所有皮质均形成了完整的骨痂。所有患者在术后三个月（13周）后均可独立行走，即使在未完全实现放射学愈合的情况下也恢复了工作。无病例出现伤口愈合问题（感染或裂开）。1例患者因小腿肌肉紧张导致踝关节背屈不完全（10°），1例患者足部背侧感觉异常，在最后一次随访（术后一年）时未改善。
即使对于营养不良性或萎缩性骨不连，增强钢板固定术也是治疗胫骨远端骨干骨不连的一种安全有效的选择。
