Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Dr. Prins is PhD candidate, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Dr. Kloen is an Orthopedic Surgeon, and Dr. Donders is PhD candidate, Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Address correspondence to: Peter Kloen, MD, PhD, Department of Orthopedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. (tel, 31-205669111; fax, 31-205669117; email, p.kloen@amc.uva.nl).
Jonne Prins, MD Johanna C.E. Donders, MD and Peter Kloen, MD, PhD . Composite Fixation of Proximal Tibial Nonunions: A Technical Trick. Am J Orthop.
September 27, 2018
TAKE-HOME POINTS
Treatment goals for a nonunion are bone union, re-establishment of (joint) stability, extremity alignment, and recovery of function.
A nonunion of a tibia plateau fracture is often associated with poor soft tissues from previous surgeries and/or infections.
Ideally a combination of minimal soft tissue damage and maximal stable fixation is used for salvage.
There is a high risk of complications when using dual plating in these cases.
A combination of an external fixator with limited internal fixation can be a good alternative.
References
ABSTRACT
Nonunion after a proximal tibia fracture is often associated with poor bone stock, (previous) infection, and compromised soft tissues. These conditions make revision internal fixation with double plating difficult. Combining a plate and contralateral 2-pin external fixator, coined composite fixation, can provide an alternative means of obtaining stability without further compromising soft tissues.
Three patients with a proximal tibia nonunion precluding standard internal fixation with double plating were treated with composite fixation. All 3 patients achieved union with deformity correction at a mean of 5.2 months (range, 5-5.5 months). The average range of motion (ROM) arc was 100° (range, 100°-115°) and postoperative ROM returned to pre-injury levels.
Composite fixation can be a helpful adjunct in the treatment of this challenging problem.
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