O2206 OUTCOME IN THE TREATMENT OF ESTABLISHED AND ANTICIPATED NON-UNION OF THE TIBIA IN CHILDHOOD

Abstract

Aims: Nonunion in long bone fractures is rare in the skeletally immature. We report the outcome of a series of patients treated for tibial bone loss and non-union at average follow-up of 52 months. Methods: Nine children aged 18 months to 17 years were treated. Three patients had established non-union ranging from 7 months to 6 years, three had bone loss (1–6cm), and three had fractures in which non-union was anticipated (1 Gustilo IIIb and 2 Tcherne IIIñs). Treatment involved wound excision for open fractures, debridement of devascularised bone and stabilisation with monolateral þxators (2 patients) and circular þxators (7 patients). Five patients had unifocal treatment; four had multifocal treatment (3 bone transports). Treatment time ranged from 3 to 12 months, and was not related to the complexity of treatment. Functional outcome was measured using the Short Musculoskeletal Functional Assessment (SMFA). Results: At the latest follow-up (average 52 months), the mean range of knee motion was 3–125û and mean ankle range was 13û dorsißexion, 35û plantarßexion. Physeal arrest was present in three children (limb length discrepancy 2–4cm) but with no deformity. Functional outcome revealed a ÒDysfunction IndexÒ of 0–19% (ave. 7%) and a ÒBother IndexÒ of 0–16% (ave. 6%). Conclusions: Limb salvage of severe tibial fractures in which nonunion were established or anticipated were worthwhile. Good function can be obtained. The duration of treatment was not related to the complexity of treatment but was increased by leaving sterile but avascular bone unexcised