Strain R, Harwood P J, Kanakaris N K, Giannoudis P V
Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.
NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK.
Indian J Orthop. 2024 Aug 18;58(12):1806-1814. doi: 10.1007/s43465-024-01235-y. eCollection 2024 Dec.
Non-union is a significant complication following open diaphyseal tibia fractures. Management can be complex and unpredictable. Several principles must be addressed often in combination to achieve union. The aim of this study is to report on the characteristics, management and eventual outcome of non-united open tibial fractures over a 12-year period from a level I trauma centre.
This is a retrospective observational study of all adults (age 18 years and older) presenting to a level 1 trauma centre with a diaphyseal tibia fracture. Non-union was diagnosed using the standard FDA definition of incomplete union by 9 months or no progress to union in the preceding 3 months. Injury and patient demographics in addition to all interventions and complications were recorded for each patient.
Forty three cases of diaphyseal non-union were identified from 2008 to 2019. Only the presence of peripheral vascular disease demonstrated a statistically significant association with the development of non-union. In 44% of cases, more than one additional operation was required to achieve union. Successful union was achieved in 90% of cases with 74% of patients returning to full pre-injury function without complication.
Management of non-union is a complex problem which requires a multifaceted and bespoke approach. We have included an algorithm to help guide decision making based on our institutional experience. A satisfactory result is achievable in the majority of patients.
胫骨骨干开放性骨折后骨不连是一种严重的并发症。其治疗可能复杂且难以预测。通常必须综合运用多项原则才能实现骨折愈合。本研究的目的是报告一家一级创伤中心在12年期间开放性胫骨骨折骨不连的特点、治疗方法及最终结果。
这是一项对所有因胫骨骨干骨折就诊于一级创伤中心的成年人（年龄18岁及以上）进行的回顾性观察研究。骨不连采用美国食品药品监督管理局（FDA）不完全愈合的标准定义，即9个月时仍未愈合或在之前3个月内骨折愈合无进展来诊断。记录每位患者的损伤情况、患者人口统计学资料以及所有干预措施和并发症。
2008年至2019年共识别出43例胫骨骨干骨不连病例。仅外周血管疾病的存在与骨不连的发生存在统计学上的显著关联。44%的病例需要进行不止一次额外手术才能实现骨折愈合。90%的病例实现了成功愈合，74%的患者恢复到受伤前的全部功能且无并发症。
骨不连的治疗是一个复杂的问题，需要多方面的定制方法。我们纳入了一种算法，以根据我们机构的经验帮助指导决策。大多数患者可取得满意的结果。
