Abstract
Post – traumatic nonunion is unusual in children. The presence of more than one site for nonunion in a single bone, infection, shortening, osteoporosis and deformity makes the treatment more complicated. Case Report: A 10-y old boy presented to us with a post-traumatic 12 cm Rt. tibial shortening, unstable knee and a discharging sinus over the upper tibia. Roentgenograms revealed 3 sites of nonunion: in the upper middle and lower 1/3 of the tibia. The deformity of the upper tibia was varus 20° and recurvatum 25° while there was varus of the lower part 15°. The fibular head was over hanging the tibia. Treatment: Ilizarov Ext. fixator was applied concomitant with freshening of the upper site, sinus excision and osteotomy of the fibula. The lower fibula was fixed to the tibia leaving the upper part free. Then, gradual correction of deformities by distraction using properly positioned hinges was applied through the upper and lower sites for nonunion. Compression – Distraction was applied alternatively to stimulate the regenerate till we reached the sum of 12 cm lengthening from the 3 sites. The fixator was removed after 9 months where there was union and consolidation from all sites for non-union. The patient was followed up for 4 years.
Complications: Included wire tract infection, mild bowing of the regenerate after fixator removal and refracture.
Conclusion: Using the nonunion sites to correct complicated deformities and lengthen the bone is an effective method in children. Up to our knowledge, this is the first time to report the results of trifocal lengthening.
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
