TIBIAL NON-UNION WITH INFECTION, WHEN TO DEBRIDE?

Abstract

Background: The majority of long bone nonunions occur in the tibia. Associations with infection, segmental bone loss, or shortening; are responsible for substantial morbidity. They are particularly recalcitrant to treatment, and consequently many alternative approaches to elicit their healing have been suggested.

Patients and Methods: Thirty three infected non-united tibial fractures (24–69y), with shortening or bone loss (3.5 – 9.5 cm.) and skin or other soft tissue complications; following repeated surgeries (3–7 previous operations) were operated upon. Seventeen fractures were subjected to debridement of the bone ends and soft tissues at the non-union site. Sixteen fractures were managed by simple compression at the fracture site. Mono-planer external fixators were applied to all cases, and distraction-callo-tasis principle was performed at a proximal (or distal) corticotomy to compensate for shortening or bone loss.

Results: In the first group: bone healing was achieved in 16 cases (94.1%) in 13 – 32 weeks (mean of 14.4 weeks). Infection was eradicated in 15 cases (88.2%); all were united. The mean length gained was 7 cm. Satisfactory results were obtained in 14 patients (82.3%) and unsatisfactory results in 3 patients (17.6%). There have been no refractures or loss of length after a follow-up of 2 years (range 2 – 2.5 y). In the second group: bone healing was achieved in 11 cases (68.7%) in 17 – 41 weeks (mean of 20.6 weeks); with infection eradication in only 7 of them (43.7%). The remaining 5 non-unions; all showed residual infection. The mean length gained was 6 cm. Satisfactory results were obtained in 8 patients (50%) and unsatisfactory results in 8 patients (50%). There have been two refractures in the united 11 cases after a follow-up of 2 years (range 2 – 2.7 y).

Conclusion: bone compression after debridement gives a higher success rate in achieving bone healing & eradication of infection in infected tibial non-union.