Combined dynamized nailing with partial fibulectomy for aseptic diaphyseal tibial nonunion in adults

Abstract

Background and aim of the study
Mechanical stability of hypertrophic nonunion remains the goal for treatment leading to bony bridging and remodeling. Partial fibulectomy or dynamization was reported with a wide range of clinical and radiological results. This study aims at assessment of combined dynamically locked nailing with partial fibulectomy technique to reach biological and mechanical stability with shorter healing time.


Patients and methods
This study included seventeen skeletally mature patients with aseptic diaphyseal hypertrophic tibial nonunion after nailing or external fixator. Patients with infected nonunion, atrophic nonunion, skeletally immature, and those with incomplete follow-up were excluded. Included patients were allocated into two groups, and final functional and radiological outcome regards healing time, union, limb alignment and rotation, knee and ankle rage of motions were reported.


Results
The mean follow-up period was 33.3 ± 6.2months. All nonunions healed successfully within 11.9 ± 1.5weeks (range: 10–16 weeks). One patient had tibial plafond injury that necessitated nail removal. The mean angle of coronal angulation was 1.4 ± 1.4°. The rotational difference between both limbs as per the thigh-foot angle was 2.5 ± 1.7°. The average functional outcome as per the Karlström-Olerud scale score was 30.9 ± 3. A significant difference was evident between the external fixator group and the nailing group in terms of functional grading scale (P=0.03).


Conclusion
The combined dynamically locked nailing with partial fibulectomy technique is a biology-preserving technique that provides mechanical stability, allows early return to functional activity with complete bone healing and no need for further surgeries.