Strategies in Trauma and Limb Reconstruction

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VOLUME 18 , ISSUE 2 ( May-August, 2023 ) > List of Articles


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

Freideriki Poutoglidou, Matija Krkovic

Keywords : Circular external fixator, Femoral non-union, Non-union, Revision surgery, Tibial non-union, Watchful waiting

Citation Information : Poutoglidou F, Krkovic M. The Cambridge Experience with Lower Limb Long Bone Non-union Following Fixation and the Treatment Algorithm. 2023; 18 (2):100-105.

DOI: 10.5005/jp-journals-10080-1589

License: CC BY-NC-SA 4.0

Published Online: 26-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


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.

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