Percutaneous injection of autologous platelet gel accelerate healing in diabetic tibial non union: On going longitudinal study.

INTRODUCTION: In this study the tibial shaft fracture non unions in diabetes mellitus are evaluated with percutaneous autologous platelet gel supplementation to accelerate union are compared with individually matched control group with autologous iliac crest bone marrow aspirate injection. MATERIAL AND METHODS: This present study was carried out on tibial non unions in diabetic patients recruited in an ongoing longitudinal study over a period of 2006 to 2017, treated by one surgeon at one institute, are included in this report. Each of 18 established tibial atrophic, aseptic non unions treated by percutaneous autologous platelets and iliac crest bone marrow aspirate were followed up on regular basis up till 9 months. The healing of non union was assessed clinically by painless full weight bearing and the radiological union was judged by bridging callus formation observed on at least 3 of 4 cortices in anteroposterior and lateral views. RESULTS: Union was observed in 17 (94.4 %) patients of the autologous platelet group. The average time to union was 9.2 weeks (range 8 to 18 weeks) after percutaneous autologous platelet injection (P < 0.0517) .In the control group, union was observed in 14 (77.8 %) patients (P = 0.672). The average time to union following percutaneous bone marrow injection was 11.6 weeks (range 9 to 28 weeks). The proximal 1/3 shaft non union healed comparatively faster than the distal 1/3 shaft tibia (P ≤ 0.0612). No correlation was observed between the comminuted and non comminuted fracture non union (P = 0.789). A significant correlation was noted as regards the non union healing time duration in patients who were on insulin and oral hypoglycemic drugs (P ≤ 0.001) and also about the total duration of diabetes mellitus in years (P ≤ 0.003). CONCLUSION: This investigation showed that percutaneous autologous platelet gel delivery is sufficient method to obtain union in diabetic tibial fracture non unions, which is less invasive procedure than bone marrow injection. The efficacy of this autologous platelets is once again well established and this study reinforced categorically the previously published report by the author.

Polytherapy versus monotherapy in the treatment of tibial non-unions: a retrospective study.

BACKGROUND: Treating tibial non-unions efficiently presents a challenge for orthopaedic trauma surgeons. The established gold standard involves implanting autologous bone graft with adequate fixation, but the addition of biologicals according to the so-called diamond concept has become increasingly popular in the treatment of non-unions. Previous studies have indicated that polytherapy, which involves implanting mesenchymal stem cells, bioactive factors and osteoconductive scaffolds, can improve bone healing. This study aims to evaluate the efficacy of polytherapy compared with monotherapy in treating tibial non-unions of varying severity. MATERIALS AND METHODS: Data from consecutive tibial non-unions treated between November 2014 and July 2023 were retrospectively analysed. The Non Union Scoring System (NUSS) score before non-union surgery, and the Radiographic Union Score for Tibial fractures (RUST), scored at 1, 3, 6, 9, 12 and 18 months post-surgery, were recorded. Initially, a comparison was made between the polytherapy and monotherapy groups. Subsequently, patients receiving additional surgical non-union treatment were documented, and the frequency of these treatments was tallied for a subsequent per-treatment analysis. RESULTS: A total of 34 patients were included and divided into a polytherapy group (n = 15) and a monotherapy group (n = 19). The polytherapy group demonstrated a higher NUSS score (44 (39, 52) versus 32 (29, 43), P = 0.019, z = -2.347) and a tendency towards a higher success rate (93% versus 68%, P = 0.104) compared with the monotherapy group. For the per-treatment analysis, 44 treatments were divided into the polytherapy per-treatment group (n = 20) and the monotherapy per-treatment group (n = 24). The polytherapy per-treatment group exhibited a higher NUSS score (48 (43, 60) versus 38 (30, 50), P = 0.030, z = -2.173) and a higher success rate (95% versus 58%, P = 0.006) than the monotherapy per-treatment group. Within the monotherapy per-treatment group, the NUSS score displayed excellent predictive performance (AUC = 0.9143). Setting the threshold value at 48, the sensitivity and specificity were 100.0% and 70.0%, respectively. CONCLUSIONS: Polytherapy is more effective than monotherapy for severe tibial non-unions, offering a higher success ratio. The NUSS score supports decision-making in treating tibial non-unions. LEVEL OF EVIDENCE: Level III.

The Cambridge Experience with Lower Limb Long Bone Non-union Following Fixation and the Treatment Algorithm.

Aim: Non-unions have been traditionally classified as atrophic, oligotrophic and hypertrophic and their management was primarily dictated by that. In our Unit, we have based our treatment rationale mainly on the stability of the metalwork and the presence of symptoms rather than the radiologic appearance of the non-union or the presence of infection. The aim was to present the treatment algorithm for lower limb long bone non-union following operative fixation. Materials and methods: All patients treated for a femoral or tibial non-union following fixation between 2014 and 2020 in our unit and with a minimum follow-up of 2 years were included. Non-union was defined as having no evidence of fracture healing in any cortices six months after the index procedure. Union was defined as bridging callus in at least three cortices visualized on at least two orthogonal radiographs. Information retrieved included demographic and fracture characteristics, presence of infection, evidence of metalwork stability and treatment. Outcome measures included union rate, time to union and complications. Data were analysed with the Statistical Program for Social Sciences (SPSS) using contingency tables and linear regression. A p-value of less than 0.05 was considered statistically significant. Results: Seventy-seven consecutive patients were included in the study. Union was achieved in 91% of the cases, while union was noted in all the patients treated non-operatively. The mean time to union was 14.49 months (9.98). Complications were encountered in 20 of the patients and the most common were docking site non-union and metalwork breakage. Infection was the only factor that affected time to union in a statistically significant manner (p = 0.006). Conclusion: The results of our study suggest that in cases of long bone non-union following operative fixation using signs of metalwork instability and the presence of clinical symptoms as the main indication for surgical intervention provides a satisfactory outcome. This approach prevented operative management in a large proportion of patients. Clinical significance: This article presents an algorithmic approach that could aid clinicians in their decision-making in long-bone non-union management. Level of evidence: Therapeutic level III. How to cite this article: Poutoglidou F, Krkovic M. The Cambridge Experience with Lower Limb Long Bone Non-union Following Fixation and the Treatment Algorithm. Strategies Trauma Limb Reconstr 2023;18(2):100-105.

Experimental assessment of changes in bone fragment position using infraread diodes on saw bone models with a hexapod fixator.

BACKGROUND: The purpose of this study was an experimental assessment of changes in bone fragment position in patients with non-union of the tibia treated with a hexapod fixator. HYPOTHESIS: We hypothesized that the use of hexapod fixators leads to differences between the planned and actual position of bone fragments. METHODS: The study was conducted in physical models of the hexapod fixator-bone fragment system. Bone fragment displacement was measured using the Optotrak Certus Motion Capture System. We assessed differences between the planned and actual position of bone fragments. RESULTS: Assessment of bone fragment compression demonstrated a difference between the target and actual correction ranging from 1.5% to 13.2% (depending on the force applied to bone fragments) for configuration 1, from17% to 21.3% for configuration 2, and from 13.2% to 17.9% for configuration 3. The achieved varus deformity correction constituted 93.7-98.4% of the target correction for configuration 2 and 98.3-98.9% of the target correction for configuration 3. Torsional deformity correction showed considerable discrepancies between the target and achieved correction, ranging from 65.6% to 83%. DISCUSSION: The value of the applied compression force had no marked effect on the differences between the target and achieved correction or on the magnitude of unintended rotational and transverse displacement of bone fragments. The use of hexapod fixators helped achieve complete correction of the simulated varus deformity; however, complete correction of torsional deformities was not achieved. Deformity correction in physical models with the use of a hexapod fixator yielded instances of unintended rotational and transverse bone-fragment displacement. The use of hexapod fixators in physical models leads to differences between the planned and actual position of bone fragments. LEVEL OF EVIDENCE: IV, case series.

Impact of intertibiofibular graft on the ankle joint: Medium-term radiologic and clinical assessment.

HYPOTHESIS: Intertibiofibular graft (ITFG) bridges tibial non-union, but blocks bimalleolar mortise opening, leading to loss of ankle dorsiflexion. The aim of the present study was to assess dorsiflexion loss and to determine whether it was associated with secondary osteoarthritis. Material and method A 2-center retrospective study included cases of tibial non-union, without initial involvement of the ankle, treated by ITFG with more than 2 years' consolidation. Clinical, functional and radiographic parameters were analyzed. Dorsiflexion stiffness was defined as<10° flexion. Symptomatic osteoarthritis was defined by radiologic joint impingement and/or osteophytosis associated with pain>4/10 on visual analog scale (VAS) restricting walking distance to less than 1 kilometer. RESULTS: Thirty-one cases were analyzed at a mean 7±2.8 years' follow-up. Mean pain on VAS was 3±2.6. Mean AOFAS score was 62.3±20.5 and mean SEFAS was 28.3±10.5. Mean dorsiflexion was significantly lower on the ITFG side, at 6.6±7.9° versus 15.1±4.8° on the healthy side. There was dorsiflexion stiffness in 26 cases. No correlation emerged between dorsiflexion stiffness and onset of osteoarthritis. CONCLUSION: Dorsiflexion was the most severely impacted motion. The rate of osteoarthritis was too low for any implication of dorsiflexion loss to be demonstrated, especially in traumatic contexts. LEVEL OF EVIDENCE: IV; retrospective study.

Augmented compression in exchange nailing for femoral and tibial non-unions accelerates time to radiographic union.

PURPOSE: Exchange nailing is widely used for the management of aseptic femoral and tibial non-union. Compressive forces markedly reduce strain, increasing rate and incidence of union. Additional compressive forces can be applied to the non-union site by using the design features of some modern nailing systems. This study hypothesises that the use of additional compression in exchange nailing results in faster time to union. METHODS: All femoral and tibial shaft non-unions were identified over a 4-year period between 2014-2018. Intraoperative compression during exchange nailing was either applied or not applied with a dedicated active compression device through the intramedullary nail. An initial 'radiographic union score for tibia' (RUST) score was calculated from preoperative lateral and AP radiographs and compared with the postoperative radiographs at 6-8 weeks. Healing was defined as bridging callus on at least three cortices (RUST > 10). RESULTS: A total of 119 patients were identified. Following application of exclusion criteria, we analysed data for 19 patients, 10 undergoing exchange nailing with intraoperative compression and 9 without. The pre-exchange RUST score was comparable between the compressed group and standard exchange group with mean of 7.11 versus 7.5 (p = 0.636). At 6-8 weeks post-op, there was a significant difference between the median RUST score in the compressed group vs standard exchange group, 11 compared to 8.39 (p = 0.001). CONCLUSIONS: Our study shows that time to union was accelerated when additional compression was applied to exchange nailing, resulting in reduced follow-up visits and number of radiographs required.

Differentially expressed microRNAs as diagnostic biomarkers for infected tibial non-union.

BACKGROUND: Infected tibial non-union is a challenging clinical complication of fracture treatment. Improper treatment of infected tibial non-union may result in high treatment costs and a long treatment period, and lead to medical disputes and decreased patient satisfaction. An increasing number of studies have indicated the significant role of microRNAs (miRNAs) in the development and progression of different bone diseases. Therefore, the identification of a specific miRNA expression profile associated with infected tibial non-union is a key step toward establishing a novel strategy for the diagnosis and treatment of infected tibial non-union. METHODS: We utilised a microarray analysis to compare the specific expression of bone tissue miRNA in patients with infected tibial non-union and closed tibial fractures. Quantitative real-time reverse transcription-polymerase chain reaction was performed to validate the microarray results. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic efficacy of the identified regulated miRNA(s) isolated from bone tissue as potential biomarker(s). RESULTS: Microarray analysis showed 20 differentially expressed miRNAs. Differential expression of miR-649, miR-29b-3p, miR-498, miR-365a-5p, miR-328-5p, and miR-345-3p was further confirmed in a validation cohort. ROC curve analyses showed an AUC (Areas Under the ROC Curve) of 0.808 (95% confidence interval [CI]: 0.675-0.940), 0.778 (95% CI: 0.634-0.921), 0.769 (95% CI: 0.619-0.919), 0.798 (95% CI: 0.662-0.933), 0.818 (95% CI: 0.690-0.945), 0.839 (95% CI: 0.715-0.963) for miR-649, miR-29b-3p, miR-498, miR-365a-5p, miR-328-5p, and miR-345-3p, respectively. The combined use of three miRNAs (miR-649, miR-328-5p, and miR-345-3p) yielded an overall diagnostic accuracy of AUC = 0.953, indicating a robust diagnostic value. CONCLUSION: Our findings highlight the role of miR-649, miR-328-5p, and miR-345-3p as novel candidate biomarkers for infected tibial non-union diagnosis, suggesting that these differentially expressed miRNAs could be utilised as novel diagnostic and therapeutic tools to identify infected tibial non-union.

Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series.

BACKGROUND: The Ilizarov external fixation technique has been widely used for the treatment of long-bone infected non-unions. After surgical infected bone resection, to allow filling of the remaining bone gap, biomaterials with antibacterial properties could be used. The aim of this study was to report outcomes of infected tibial non-unions treated using the Ilizarov technique and antibacterial bioactive glass. METHODS: Between April 2009 and December 2014, 26 patients with infected tibial non-unions were treated with the Ilizarov technique and possible use of the bioactive glass, S53P4. The Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, a clinical and radiographic evaluating tool, was used for assessing the sample. RESULTS: The average age at the start of treatment was 51 years. The mean follow-up time was 113 weeks. According to the ASAMI Functional Scoring System, 10 excellent (38.5%) cases and 12 good (46.1%) values were recorded. According to the ASAMI Radiological System, they were excellent in 16 (61.5%) cases and good in nine (34.6%). CONCLUSIONS: Treatment of infected tibial non-unions using the Ilizarov technique was effective in bone segment regeneration. To fill the remaining bone gap, additional bioactive glass S53P4 could be used, allowing a decrease in re-interventions and minimizing complications.

Modelo predictivo de la no unión de tibia / Tibia non union predictive model

OBJETIVOS: Estimar un modelo predictivo para la no-unión en pacientes que presentan fractura de tibia. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectivo, en pacientes con fractura de tibia operadas entre 2012 y 2018, con un mínimo de 12 meses de seguimiento, excluyendo amputaciones traumáticas. Realizamos un modelo de regresión logística con 13 variables descritas en la literatura. Se descartaron las variables estadísticamente no significativas y las que no causaban efecto de confusión. Se evaluó la bondad de ajuste mediante el test de Hosmer-Lemeshow y la discriminación del modelo con la curva ROC. RESULTADOS: Se incluyeron 411 fracturas de tibia, las variables estadísticamente significativas fueron: exposición ósea OR » 2,57(IC:1,15­5,75, p » 0,022), diabetes OR » 3,29 (IC:1,37­7,91, p » 0,008) y uso de tutor externo OR » 1,77(IC:0,81­3,85), el que tuvo efecto de confusión. La bondad de ajuste demostró que los datos se ajustan adecuadamente al modelo (p » 0,35). La curva ROC demuestra un 70,91% de poder discriminatorio. Al evaluar aisladamente las fracturas expuestas, no hubo asociación estadísticamente significativa con ninguna variable. DISCUSIÓN: Al evaluar el modelo, obtuvimos una asociación estadísticamente significativa entre: no unión, exposición ósea, diabetes y uso de tutor externo, información concordante con la literatura. Al estudiar el subgrupo de fracturas expuestas, las demás variables son estadísticamente no significativas. Eso refleja que la exposición ósea es la variable que confiere mayor riesgo. El seguimiento adecuado de esos pacientes es fundamental dado este alto riesgo de evolucionar con no-unión. CONCLUSIÓN: En nuestra serie, la exposición ósea es el factor de riesgo más importante para presentar no unión de tibia.

OBJECTIVES: Estimate a predictive model for non-union in patients presenting with a tibial fracture. MATERIALS AND METHODS: Retrospective cohort study in patients with tibia fractures operated between 2012 and 2018, with a minimum follow-up of 12 months, excluding traumatic amputations. We performed a multivariate logistic regression model with 13 variables described in the literature. The variables that were statistically non-significant and those variables that do not cause confusion, were discarded. Goodness of fit was evaluated using the Hosmer-Lemeshow test and the discrimination of the model with the ROC curve. RESULTS: 411 tibial fractures were included, the statistically significant variables were: bone exposure OR » 2.57(CI:1.15­5.75, p » 0.022), diabetes OR » 3.29(CI:1.37­7.91, p » 0.008) and use of external fixation OR » 1.77(CI:0.81­3.85), being included in the model because of its confounding effect. Goodness of fit demonstrates that the data fit the model adequately(p » 0.35). The ROC curve demonstrates 70.91% discriminatory power. When evaluating the exposed fractures in isolation, there was no statistically significant association with any variable. DISCUSSION: When evaluating the model, we obtained a statistically significant association between non-union, bone exposure, diabetes and use of external fixation, being consistent with the literature. When studying the subset of exposed fractures, the other variables are statistically non-significant. This reflects that bone exposure is the variable that confers the greatest risk. Proper follow-up of these patients is essential given this high risk of evolving with non-union. CONCLUSION: In our series, bone exposure is the most important risk factor for presenting tibial non-union.

The use of a gentamicin-coated titanium nail, combined with RIA system, in the management of non-unions of open tibial fractures: A single centre prospective study.

BACKGROUND: Nonunion is a quite common complication of open tibial shaft fractures. This prospective case series investigates the use of the gentamicin-coated titanium intramedullary tibial nail, in association with the RIA system, in patients with tibial exposed nonunions. METHODS: Between January 2015 and January 2018, patients meeting the inclusion and exclusion criteria were recruited. INCLUSION CRITERIA: patients aged 18 or more; non-union after an open tibial shaft fracture; previous treatment with a circular external fixator. EXCLUSION CRITERIA: a known allergy to aminoglycosides; pin tract infections; persistent soft-tissues damage; patients pregnant, breastfeeding or planning to become pregnant during the study; history of malignant disease; a life expectancy of fewer than three months; medical illness or cognitive disorders precluding participation in the follow-up examination. All the patients underwent a clinical and radiological follow-up at one-, three-, six- and twelve-months post-operatively. Clinical evaluation was performed using the following validated scores: Euro-Quality 5 D (EQ-5D); American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the Visual Analogue Scale (VAS) for pain. RESULTS: Seventeen patients met the inclusion and exclusion criteria (male: 11; female: 6; mean age: 41.12 ± 11.4). Fracture healing was observed in all the patients; the mean time needed to obtain the fracture healing was 7.18 months. A significant improvement of the quality of life, evaluated with the EQ-5D, and of the mean VAS for pain was observed from the three-months follow-up. The mean AOFAS score showed a significant increase at six-months follow-up. CONCLUSIONS: The use of gentamicin-coated nails in association with the RIA system demonstrated a safe and effective treatment of tibial non-unions.

Intra-medullary osteosclerosis of the tibia in children.

BACKGROUND: Intra-medullary osteosclerosis of the tibia is a rare condition characterised by chronic pain due to diaphyseal hyperostosis with no detectable triggering factor. The main differential diagnoses are stress fracture and osteoid osteoma. Of the few cases reported to date, most were in adults. The objective of this study was to assess paediatric patients with intra-medullary osteosclerosis to determine whether the first visit provides sufficient information to establish the diagnosis and rule out both osteoid osteoma and stress fracture, whether a biopsy is required, and which treatment is optimal. HYPOTHESIS: The diagnosis of intra-medullary osteosclerosis of the tibia can be made at the first visit. PATIENTS AND METHODS: Seven paediatric patients, 4 males and 3 females, with a mean age of 11 years, were included in this retrospective study. We evaluated the clinical features, findings from imaging studies (standard radiographs, computed tomography, magnetic resonance imaging, and bone scintigraphy), and treatment outcomes. RESULTS: At the first visit, all patients had a painful swelling at the middle of the shin and imaging study evidence of antero-lateral tibial cortical thickening extending into the medullary cavity; in 5 patients, a linear lucency was visible. No other bone abnormalities were seen. Treatments included non-operative measures, pinning, and nailing. None of these treatments provided permanent bone healing or pain relief, although transitory freedom from pain with or without radiological bone healing was achieved. DISCUSSION: Intra-medullary osteosclerosis of the tibia is rarely reported and therefore probably underdiagnosed. Distinctive characteristics of the cortical and endosteal thickening include location at the antero-lateral mid-diaphysis and, in some cases, the concomitant presence of a linear lucency that can provide the early diagnosis. The distinctive radiological features allow differentiation from a stress fracture. The management is challenging. LEVEL OF EVIDENCE: IV, retrospective observational study.

Extra-articular deformity correction using Taylor spatial frame prior to total knee arthroplasty.

A good long-term outcome following a total knee arthroplasty relies on restoration of the mechanical axis and effective soft tissue balancing of the prosthetic knee. Arthroplasty surgery in patients with secondary osteoarthritis of the knee with an extra-articular tibial deformity is a complex and challenging procedure. The correction of mal-alignment of the mechanical axis is associated with unpredictable result and with higher revision rates. Single-staged deformity correction and replacement surgery often result in the use of constraint implants. We describe our experience with staged correction of deformity using a Taylor Spatial Frame (TSF) followed by total knee arthroplasty in these patients and highlight the advantage of staged approach. The use of TSF fixator for deformity correction prior to a primary total knee arthroplasty has not been described in the literature. We describe three cases of secondary osteoarthritis of the knee associated with multiplanar tibial deformity treated effectively with a total knee arthroplasty following deformity correction and union using a TSF. All patients had an improved Knee Society score and Oxford Knee score postoperatively and were satisfied with their replacement outcome. Staged deformity correction followed by arthroplasty allows the use of standard primary arthroplasty implants with predicable results and flexible aftercare. This approach may also provide significant improvement of patient symptoms following correction of deformity resulting in deferment of the arthroplasty surgery.

Treatment of aseptic tibial shaft non-union without bone defect.

Non-union is incomplete consolidation of a fracture, without effective formation of a uniting callus. Despite better understanding of the physiology of bone consolidation, management of tibial non-union remains a challenge for orthopedic surgeons. Several treatments have been developed in recent decades, and we now have a range of techniques, with indications based on type of non-union, prior treatments, available equipment, and the surgeon's experience. Firstly, there are surgical techniques such as osteo-periosteal decortication, cancellous iliac graft, or inter-tibiofibular graft. The decision to fix the non-union (or revise existing fixation) and choice of type of internal fixation depend on the stability of the fracture site. There are also non-operative biological and biochemical consolidation stimulation techniques: local injection of bone-marrow, platelet-rich plasma (PRP) or bone morphogenetic protein (BMP). Stimulation can also be physical, applying ultrasound or an electromagnetic field to the non-union site. Each technique may be used in isolation or association.

A Novel 'Transfibular Approach' for the Nonunion of a Tibial Shaft Fracture with Poor Anteromedial Soft Tissue Cover.

The need for an ideal approach for the nonunion of the tibial shaft with anteromedial soft tissue scarring has long baffled surgeons. Many different approaches have been suggested in the past, but all those approaches were haggled by a multitude of problems. We have described a novel 'transfibular approach' for this selective situation. An appropriate patient with a mid-shaft tibial non-union was selected. After preoperative workup, the patient underwent an open reduction internal fixation (ORIF) with lateral tibial plating, bone grafting, and partial fibulectomy. In this new approach, the plane between tibialis anterior and extensor hallucis longus was used combined with a conventional posterolateral approach using the same incision. Subsequently, the patient was followed up for adequacy of the fixation and wound-related problems with a convincing outcome.

One-stage reconstruction with open bone grafting and vacuum-assisted closure for infected tibial non-union.

INTRODUCTION: Non-union of the tibia complicated by osteomyelitis is one of the most challenging problems in orthopaedic surgery. There remains a significant amount of debate and controversy regarding the optimal medical management of infected tibial non-union. There are few articles which have reported the outcomes of treatment for infected non-union of tibia from single-stage reconstruction with open bone grafting plus vacuum-assisted closure (VAC). MATERIAL AND METHODS: Our report covers experience between March 2007 and February 2010 of open bone grafting plus VAC in one stage for patients with infected tibial non-union. The time for bone union and wound healing to occur, the duration of hospitalisation, and the rate of resolution of infection were all analysed. The main outcome measures were based on a clinical scoring system that assessed functional ability, range of knee and ankle motion, shortening, infection and pain. Fifteen patients were involved in this study. RESULTS: All patients were followed up for an average of 22.6 months (range: 14-42 months). Bone union was achieved in 93.3% (14/15) of patients after a mean of 5.93 months (range: 3-10 months). All wounds healed within an average period of 5 weeks (range: 3-10 weeks), and the function and appearance of all limbs were satisfactory. CONCLUSIONS: Open bone grafting combined with VAC in a one-stage procedure can be a feasible alternative to the treatment of infected tibial non-union, especially for those wounds which are not good candidates for microsurgery; however, further studies are required to confirm the likely benefits.

Clinical outcomes of the Ilizarov method after an infected tibial non union.

BACKGROUND: The Ilizarov technique has been used in the UK for the last 20 years in the management of infected non-union of long bones. This method uses fine wires inserted percutaneously which are attached and tensioned to provide a strong frame construct. The majority of tibial and femoral non unions can be treated successfully by internal fixation. However, an infected non-union of the tibia can prove a difficult problem. The Ilizarov method can prove useful for treating these complex injuries. OBJECTIVES: To assess whether a new limb reconstruction centre in the UK has comparable results. PATIENTS AND METHODS: Twelve patients (10 M: 2 F; Avg age 43.3 years) who had an infected tibial non-union between March 2009 and August 2010 treated with the Ilizarov technique. Intervention method was Ilizarov technique and main outcome measures include functional and radiological outcomes assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analogue Pain scores. RESULTS: All twelve patients united. None required amputation. Mean time to union was 46 weeks (range 24 - 70/median 50). The average follow up time was 62 weeks (39 - 164/ median 59). According to the ASAMI score bone/radiological results ten were classed as excellent with the remainder being good. Functionally six were graded as excellent, four as good and two as poor. The average AOFAS score was 83/100 (70 - 90) and pain visual analogue scale (VAS) was two. CONCLUSIONS: Our results in terms of ASAMI scores are comparable with the published literature. Furthermore, our return to work is better than most European studies (63%). All our patients said they would have the procedure again. We attribute this success partly to the multidisciplinary approach. We recommend early referral to a dedicated unit if there is any evidence of a non-union.