Abstract
Purpose: Treatment of non-infected nonunion of the leg is a difficult challenge. Several technical solutions have been proposed. The purpose of this work was to assess the results achieved in patients treated with the Kuntscher technique and to detail indications.
Material and methods: Twenty-two patients who underwent surgery between 1987 and 1997 using the Kuntscher technique (reaming, renailing) for tibial nonunion were reviewed. There were 19 men and three women, mean age 36 years (range 16–58). Minimal follow-up was two years. The initial treatment consisted in non-locked cen-tromedular nailing the cruropedious (n=21) and screw-plate fixation (n=1). There were ten open fractures: Gustilo I (n=3), II (n=7). We noted: time to revision, time to healing, preoperative and last follow-up alignment, size and type of bone loss (fragment or segment), complementary procedures, complications.
Results: We had one infectious failure (Kuntschner nine months after screw-plate fixation, infection diagnosed at two months, bone healing after removal of the nail, reaming, external fixation and fibular strut with cancellous graft). There were no other complications. One patient was lost to follow-up at three months; this patient had a medial fragmental gap measuring 1 cm with a radiologically solid fracture at last follow-up. All other patients healed within a mean 3.44 months (2.5–10). Mean time before revision was six months (2.5–12). Segmental loss was 3–8 cm in six patients. There was not defective alignment at healing. A fibular osteotomy was performed in five cases. Complete weight bearing was initiated early in 15 patients (with crutches in seven).
Discussion: In our experience, the Kuntscher technique is a simple and effective method for the treatment of non-infected tibial nonunions. It is indicated for small gaps or small-sized segmental losses. The rapidity of the healing and the generally uneventful healing period suggest this method should be proposed early after diagnosis of nonunion.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
