Evaluation of nonunions of the tibia diaphysis - own experience.

BACKGROUND: Delayed union is not an expected outcome of treatment of a bone fracture. The cause of the delayed union must be established before treatment of the complication can be undertaken. The method of treatment depends mainly on the specific nature of delayed bone union. The study evaluates the causes of delayed bone union during treatment of tibial shaft fractures. MATERIAL AND METHODS: Seventy-two patients with delayed union following a fracture of the tibial diaphysis were treated in the Department of Orthopaedics and Musculoskeletal Traumatology of Wroclaw Medical University between 1995 and 2005. All patients had received previous treatment of the fractures. Depending on the morphology of the delayed union, the treatment was with Ilizarov's compression-distraction method or autologous osteoplasty with intramedullary, internal or external fixation. The choice of a method was based on an analysis of the features of the non-union while fracture morphology, presence of other concomitant sequelae of the original injury, fixation method and possible surgical errors, post-operative patient management, co-morbidity and patient compliance were evaluated as risk factors of delayed bone union. The risk factors were subdivided into treatment-dependent (external) and treatment-independent (internal). Treatment outcomes were evaluated on the basis of an orthopaedic examination and radiographic evidence. RESULTS: In the vast majority of patients, delayed union of the tibial diaphysis was due to external factors. CONCLUSIONS: Delayed union of the tibia can be avoided through early and simultaneous treatment of all sequelae of the original trauma. Patient management must be based on state-of-the-art medical knowledge.