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HOME > J Musculoskelet Trauma > Volume 27(4); 2014 > Article
Original Article
The Efficacy of Preserved Posterior Cortex in the Treatment of Infected Nonunion of the Tibia
Hyoung-Min Kim, M.D., Il-Jung Park, M.D., Youn-Tae Roh, M.D., Byung-Min Kang, M.D., Hyun-Jin Lee, M.D., Jae-Young Lee, M.D.
Journal of the Korean Fracture Society 2014;27(4):301-307.
DOI: https://doi.org/10.12671/jkfs.2014.27.4.301
Published online: October 20, 2014

Department of Orthopedic Surgery, The Catholic University of Korea, Buchon St. Mary's Hospital, Bucheon, Korea.

Address reprint requests to: Jae-Young Lee, M.D. Department of Orthopedic Surgery, The Catholic University of Korea, Buchon St. Mary's Hospital, 327 Sosa-ro, Wonmi-gu, Bucheon 420-717, Korea. Tel: 82-32-340-7099, Fax: 82-32-340-2671, osleejy@catholic.ac.kr
• Received: April 30, 2014   • Revised: June 22, 2014   • Accepted: August 28, 2014

Copyright © 2014 The Korean Fracture Society. All rights reserved.

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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  • Purpose
    We studied the efficacy of preserved posterior cortex connecting to adjacent muscle or periosteum during wide debridement in the treatment of infected nonunion of the tibia.
  • Materials and Methods
    From January 2001 to May 2011, 12 cases of infected nonunion of the tibia with segmental defect larger than 4 cm after wide debridement were selected. The selected cases were categorized according to two groups; group 1 with preserved posterior cortex in the segmental defect site - six cases, group 2 without posterior cortex - six cases. The results were compared by assessing the size of bone defect, the interval between wide debridement and bone reconstruction, bony union time, complications, and clinical results.
  • Results
    The mean length of bone defect of group 1 was 7.6 cm (range 4.3-11.0 cm) and that of group 2 was 6.4 cm (range 4.0-12.0 cm). The interval between wide debridement and bone reconstruction was 10.0 weeks (range 5-18 weeks) for group 1, and 12.1 weeks (range 0-24 weeks) for group 2. The time for bony union of group 1 was 6.2 months (range 5-7 months), and that of group 2 was 10.8 months (range 7-18 months). In group 2, there were two cases of fatigue fracture and two cases of docking site nonunion after distraction osteogenesis.
  • Conclusion
    The preserved posterior cortex after wide debridement of infected nonunion of the tibia helps bony union and reduces the treatment period.
  • Key words: Tibia, Infected nonunion, Posterior cortex
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Fig. 1
A 62-year-old male with an open comminuted fracture showing a segmental defect of the left tibia and fibula. Infection developed after external and internal fixation with a vascularized fibular graft. (A) Approximately 10.0 cm sized segmental bone loss with soft tissue defect. (B) Preserved posterior cortex (arrow) after wide debridement of the infected bone. (C) Proximal tibia plating with autogenous cancellous iliac bone graft. (D) A successful union six months after autogenous cancellous iliac bone graft.
jkfs-27-301-g001.jpg
Fig. 2
A 44-year-old male with a comminuted fracture of the right tibia and fibula. Infection developed after open reduction and internal fixation using plates. (A) Active draining nonunion with soft tissue defect. (B) Isolated healthy posterior cortex (arrow) is preserved after wide debridement. Approximately 11 cm sized segmental bone defect is noted. (C) Autogenous cancellous iliac bone graft and plating three months after wide debridement. (D) A successful union seven months after autogenous cancellous iliac bone graft.
jkfs-27-301-g002.jpg
Table 1
Summary of Cases
jkfs-27-301-i001.jpg

AIBG: Autogenous iliac bone graft, VFG: Vascularized fibular graft, DO: Distraction osteogenesis.

Figure & Data

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        The Efficacy of Preserved Posterior Cortex in the Treatment of Infected Nonunion of the Tibia
        J Korean Fract Soc. 2014;27(4):301-307.   Published online October 31, 2014
        DOI: https://doi.org/10.12671/jkfs.2014.27.4.301
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      The Efficacy of Preserved Posterior Cortex in the Treatment of Infected Nonunion of the Tibia
      Image Image
      Fig. 1 A 62-year-old male with an open comminuted fracture showing a segmental defect of the left tibia and fibula. Infection developed after external and internal fixation with a vascularized fibular graft. (A) Approximately 10.0 cm sized segmental bone loss with soft tissue defect. (B) Preserved posterior cortex (arrow) after wide debridement of the infected bone. (C) Proximal tibia plating with autogenous cancellous iliac bone graft. (D) A successful union six months after autogenous cancellous iliac bone graft.
      Fig. 2 A 44-year-old male with a comminuted fracture of the right tibia and fibula. Infection developed after open reduction and internal fixation using plates. (A) Active draining nonunion with soft tissue defect. (B) Isolated healthy posterior cortex (arrow) is preserved after wide debridement. Approximately 11 cm sized segmental bone defect is noted. (C) Autogenous cancellous iliac bone graft and plating three months after wide debridement. (D) A successful union seven months after autogenous cancellous iliac bone graft.

      Fig. 1

      Fig. 2

      The Efficacy of Preserved Posterior Cortex in the Treatment of Infected Nonunion of the Tibia

      Summary of Cases

      AIBG: Autogenous iliac bone graft, VFG: Vascularized fibular graft, DO: Distraction osteogenesis.
      Table 1 Summary of Cases

      AIBG: Autogenous iliac bone graft, VFG: Vascularized fibular graft, DO: Distraction osteogenesis.

      Table 1

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