Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 17 , ISSUE 2 ( May-August, 2022 ) > List of Articles


Transfocal Osteotomy to Treat Shear (Oblique) Non-union of Tibia

Om Lahoti, Naveen Abhishetty, Mohannad Al-Mukhtar

Keywords : Aseptic non-union, Biomechanics, Cohort study, Compression force, Fracture geometry, Osteotomy, Shear force, Taylor Spatial Frame, Tibia

Citation Information : Lahoti O, Abhishetty N, Al-Mukhtar M. Transfocal Osteotomy to Treat Shear (Oblique) Non-union of Tibia. 2022; 17 (2):117-122.

DOI: 10.5005/jp-journals-10080-1555

License: CC BY-NC-SA 4.0

Published Online: 28-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aseptic non-unions of tibial shaft fractures often need surgical treatment which carry significant socio-economic implications. The causes for non-union include patient co-morbidities, high energy trauma, open fractures and fracture geometry. Oblique fractures are subject to shear forces and, if not adequately neutralised, will fail to unite. Experiments have shown that callus formation is poor in oblique fractures due to local shear stresses. We report a technique of minimally invasive transfocal transverse osteotomy and compression in a hexapod circular fixator, Taylor Spatial Frame (TSF) for 12 patients treated with a shear non-union of tibia between 2010 and 2019. There are four female and eight male patients. The average age is 49 years (range from 26 to 72 years). The fracture pattern was oblique (30–45°) in all cases. Healing of the non-union occurred in 12 cases with one case needed additional treatment with bone marrow aspirate and demineralized bone matrix. The technique of creating a minimally invasive transfocal transverse osteotomy through the oblique non-union of tibia and the use of a hexapod circular fixator to compress the osteotomy is described and adds to the range of treatments available for aseptic non-union of tibia.

PDF Share
  1. Antonova E, Le TK, Burge R, et al. Tibia shaft fractures: costly burden of nonunions. BMC Musculoskeletal Disord 2013;14(1):42. DOI: 10.1186/1471-2474-14-42.
  2. Santolini E, West R, Giannoudis PV. Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence. Injury 2015;46:S8–S19. DOI: 10.1016/S0020-1383(15)30049-8.
  3. Aro HT, Chao EY. Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression. Clin Orthop Relat Res 1993;(293):8–17. PMID: 8339513.
  4. Aro HT, Wahner HT, Chao EY. Healing patterns of transverse and oblique osteotomies in the canine tibia under external fixation. J Orthop Trauma 1991;5(3):351–364. DOI: 10.1097/00005131-199109000- 00016.
  5. Puno RM, Teynor JT, Nagano J, et al. Critical analysis of results of treatment of 201 tibial shaft fractures. Clin Orthop Relat Res 1986;(212):113–121. PMID: 3769277.
  6. Park DH, Bradish CF. An intraoperative method of calculating the mounting parameters for the Taylor Spatial Frame using the image intensifier. Ann R Coll Surg Engl 2011;93(3):260–261. DOI: 10.1308/003588411X12851639107395g.
  7. Binkley JM, Stratford PW, Lott SA, et al. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther 1999;79(4):371–383. PMID: 10201543.
  8. Mehta SP, Fulton A, Quach C, et al. Measurement properties of the Lower Extremity Functional Scale: a systematic review. J Orthop Sports Phys Ther 2016;46(3):200–216. DOI: 10.2519/jospt.2016.6165.
  9. Pan SL, Liang HW, Hou WH, et al. Responsiveness of SF-36 and Lower Extremity Functional Scale for assessing outcomes in traumatic injuries of lower extremities. Injury 2014;45(11):1759–1763. DOI: 10.1016/j.injury.2014.05.022.
  10. Rupp M, Biehl C, Budak M, et al. Diaphyseal long bone nonunions–types, aetiology, economics, and treatment recommendations. Int Orthop 2018;42(2):247–258. DOI: 10.1007/s00264-017- 3734-5.
  11. Kanakaris NK, Giannoudis PV. Locking plate systems and their inherent hitches. Injury 2010;41(12):1213–1219. DOI: 10.1016/j.injury.2010.09.038.
  12. Augat P, Burger J, Schorlemmer S, et al. Shear movement at the fracture site delays healing in a diaphyseal fracture model. J Orthop Res 2003;21(6):1011–1017. DOI: 10.1016/S0736-0266(03)00098-6.
  13. Elkins J, Marsh JL, Lujan T, et al. Motion predicts clinical callus formation: construct-specific finite element analysis of supracondylar femoral fractures. J Bone J Surg Am 2016;98(4):276. DOI: 10.2106/JBJS.O.00684.
  14. Tsang ST, Mills LA, Frantzias J, et al. Exchange nailing for nonunion of diaphyseal fractures of the tibia: our results and an analysis of the risk factors for failure. Bone Joint J 2016;98-B(4):534–541. DOI: 10.1302/0301-620X.98B4.34870.
  15. Court-Brown CM, Keating JF, Christie J, et al. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg Br 1995;77(3):407–411. PMID: 7744925.
  16. Giannoudis PV, Einhorn TA, Marsh D. Fracture healing: The diamond concept. Injury 2007;38:S3–S6. DOI: 10.1016/s0020-1383(08)70003-2.
  17. Giannoudis PV, Gudipati S, Harwood P, et al. Long bone non-unions treated with the diamond concept: a case series of 64 patients. Injury 2015;46:S48–S54. DOI: 10.1016/S0020-1383(15)30055-3.
  18. Moghaddam A, Zietzschmann S, Bruckner T, et al. Treatment of atrophic tibia non-unions according to ‘diamond concept’: results of one-and two- step treatment. Injury 2015;46:S39–S50. DOI: 10.1016/S0020-1383(15)30017-6.
  19. Kershaw CJ, Cunningham JL, Kenwright J. Tibial external fixation, weight bearing, and fracture movement. Clin Orthop Relat Res 1993;(293):28–36. PMID: 8339493.
  20. Metcalfe AJ, Saleh M, Yang L. Asymmetrical fracture fixation: stability of oblique fractures is influenced by orientation. Clin Biomech (Bristol, Avon) 2005;20(1):91–96. DOI: 10.1016/j.clinbiomech.2004.09.003.
  21. Elliott DS, Newman KJ, Forward DP, et al. A unified theory of bone healing and nonunion: BHN theory. Bone Joint J 2016;98-B(7): 884–891. DOI: 10.1302/0301-620X.98B7.36061.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.