HUNTINGTON METHOD FOR THE TREATMENT OF TIBIAL NONUNION: A RETROSPECTIVE ANALYSIS OF 11 CASES

Abstract

Purpose: Nonunion of the tibia is a therapeutic challenge requiring a good understanding of bone healing, bone substance loss and skin trophicity disorders. The fibula pro tibia Huntington procedure consists in transposing the homolateral fibula onto the injured tibia. This allows bridging the bone defect, realignement and stabilisation of the nonunion segment.

Material and methods: This retrospective series included eleven patients (ten men and one woman), mean age 32 years (16–62). The cause of the injury was a traffic accident in six cases, defenestration in one, adamatinoma in one and osteomyelitis in one. The skin was broken in nine patients with septic nonunion in seven. Mean follow-up was 13 years (1–21).

Results: Mean delay to healing was 10.5 months (8.5 for post-traumatic nonunions) and was achieved in eight cases. A higher tibial nonunion persisted after resection of an adamantinoma measuring 22 cm and two patients had to be amputated in a context of acute suppuration. Walking without crutches was possible for eight patients whose tibia had healed and the mean pain score was 2 / 10.

Discussion: Several solutions can be proposed for patients with a tibial nonunion. The inter-tibiofibular graft requires a large bone graft in patients who have already had several operations. Th Papineau method only provides cancellous bone which is mechanically weak. The Ilizarov method can allow bone transfer and dynamisation of the nonunion with compression distraction. Microanastomosis transfers using a free fibula require a trained team with the risk of potential infection of the anastomoses in these infected patients. The Huntington method has the advantage of providing osteosynthesis without the inconvenients of inert material. The fibular acts like a biological plate with good vascularisation and stability to realign and lengthen the tibial segment.

Conclusion: This surgical technique is a supplementary therapeutic means for treating (septic) nonunion of the tibia. It is easy to perform and may be the last salvage method. The advantages are: a solid compact graft fixed in the mechanical axis of the tibia, possibility of bridging bone loss of more than 28 cm, short operative time without risk of complications related to graft harvesting, shorter hospital stay.