J Korean Fract Soc.  2014 Oct;27(4):301-307. 10.12671/jkfs.2014.27.4.301.

The Efficacy of Preserved Posterior Cortex in the Treatment of Infected Nonunion of the Tibia

• Kim HM
• Park IJ
• Roh YT
• Kang BM
• Lee HJ
• Lee JY

• KMID: 2015486
• DOI: http://doi.org/10.12671/jkfs.2014.27.4.301

Abstract

PURPOSE
We studied the efficacy of preserved posterior cortex connecting to adjacent muscle or periosteum during wide debridement in the treatment of infected nonunion of the tibia.
MATERIALS AND METHODS
From January 2001 to May 2011, 12 cases of infected nonunion of the tibia with segmental defect larger than 4 cm after wide debridement were selected. The selected cases were categorized according to two groups; group 1 with preserved posterior cortex in the segmental defect site - six cases, group 2 without posterior cortex - six cases. The results were compared by assessing the size of bone defect, the interval between wide debridement and bone reconstruction, bony union time, complications, and clinical results.
RESULTS
The mean length of bone defect of group 1 was 7.6 cm (range 4.3-11.0 cm) and that of group 2 was 6.4 cm (range 4.0-12.0 cm). The interval between wide debridement and bone reconstruction was 10.0 weeks (range 5-18 weeks) for group 1, and 12.1 weeks (range 0-24 weeks) for group 2. The time for bony union of group 1 was 6.2 months (range 5-7 months), and that of group 2 was 10.8 months (range 7-18 months). In group 2, there were two cases of fatigue fracture and two cases of docking site nonunion after distraction osteogenesis.
CONCLUSION
The preserved posterior cortex after wide debridement of infected nonunion of the tibia helps bony union and reduces the treatment period.

Keyword

Tibia; Infected nonunion; Posterior cortex

MeSH Terms

Debridement
Fractures, Stress
Osteogenesis, Distraction
Periosteum
Tibia*

Figure

• 

  Fig. 1 A 62-year-old male with an open comminuted fracture showing a segmental defect of the left tibia and fibula. Infection developed after external and internal fixation with a vascularized fibular graft. (A) Approximately 10.0 cm sized segmental bone loss with soft tissue defect. (B) Preserved posterior cortex (arrow) after wide debridement of the infected bone. (C) Proximal tibia plating with autogenous cancellous iliac bone graft. (D) A successful union six months after autogenous cancellous iliac bone graft.

• 

  Fig. 2 A 44-year-old male with a comminuted fracture of the right tibia and fibula. Infection developed after open reduction and internal fixation using plates. (A) Active draining nonunion with soft tissue defect. (B) Isolated healthy posterior cortex (arrow) is preserved after wide debridement. Approximately 11 cm sized segmental bone defect is noted. (C) Autogenous cancellous iliac bone graft and plating three months after wide debridement. (D) A successful union seven months after autogenous cancellous iliac bone graft.

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