3 years ago

High Rate of Union for Aseptic Distal Tibial Nonunions in Adults Treated With Slow Gradual Compression via Circular External Fixation

Brinker, Mark R., O'Connor, Daniel P., Cunningham, Bryce A.
Objective: To evaluate the healing rate of aseptic nonunions of the distal third of the tibia treated with Ilizarov slow gradual compression and deformity correction. Design: Retrospective cohort study. Setting: Tertiary referral center. Patients/Participants: Ninety-four consecutive adult patients with 94 distal third tibial aseptic nonunions. Intervention: Ilizarov external fixation and slow gradual compression; most patients also underwent bone grafting, deformity correction, or both before the initiation of compression. Main Outcome Measurements: Rate of bony union. Results: Eighty-seven of 94 cases (92.6%) healed after slow gradual compression across the nonunion site with a circular external fixator. Four of the 7 patients who failed treatment healed after additional operative treatment, and the remaining 3 refused further care. Conclusions: Circular external fixation with slow gradual compression was successful in treating aseptic nonunions of the distal third of the tibia in 92.6% of cases. Careful selection of patients for this treatment method can lead to a high success rate with a relatively low rate of major complications. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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