Sung Soo Kim; Sung Keun Shon; Kyu Yeol Lee; Chul Hong Kim; Myung Jin Lee; Min Soo Kang; Lih Wang; Im Sic Ha

doi:10.12671/jkfs.2008.21.4.279

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Original Article
Cause and Treatment of Extraarticular Proximal Tibial Nonunion: Sung Soo Kim, M.D., Sung Keun Shon, M.D., Kyu Yeol Lee, M.D., Chul Hong Kim, M.D., Myung Jin Lee, M.D., Min Soo Kang, M.D., Lih Wang, M.D., Im Sic Ha, M.D.; Journal of the Korean Fracture Society 2008;21(4):279-285.
DOI: https://doi.org/10.12671/jkfs.2008.21.4.279
Published online: October 31, 2008

Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea.

^*Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea.

Address reprint requests to: Lih Wang, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 3-1, Dongdaesin-dong, Seo-gu, Busan 602-715, Korea. Tel: 82-51-240-2593, Fax: 82-51-254-6757, libi33@dau.ac.kr

• Received: March 13, 2008 • Accepted: October 6, 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

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.
Key words: Proximal tibia, Extraarticular fracture, Nonunion

REFERENCES

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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.

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.

Table 1

Functional results of the nonunion patients by Klemm and Börner classification

Table 2

Data analysis of proximal tibial nonunion patients

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

Table 3

Statistic analysis of nonunion rate related to risk factors

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

Figure & Data

REFERENCES

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Cause and Treatment of Extraarticular Proximal Tibial Nonunion

J Korean Fract Soc. 2008;21(4):279-285. Published online October 31, 2008

DOI: https://doi.org/10.12671/jkfs.2008.21.4.279

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Figure

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Cause and Treatment of Extraarticular Proximal Tibial Nonunion

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.

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.

Fig. 1

Fig. 2

Cause and Treatment of Extraarticular Proximal Tibial Nonunion

Table 1

Functional results of the nonunion patients by Klemm and Börner classification

Table 2

Data analysis of proximal tibial nonunion patients

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

Table 3

Statistic analysis of nonunion rate related to risk factors

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

Table 1 Functional results of the nonunion patients by Klemm and Börner classification

Table 2 Data analysis of proximal tibial nonunion patients

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