The outcome of tibial non-union treatment using a revised definition, classification system and management strategy.
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Date
2015
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Abstract
The management of tibial non-unions remains a challenge for orthopaedic surgeons. The
treatment of tibial non-unions is historically based on small case series that frequently include a
variety of non-union subtypes and infected cases. Fixation methods and treatment strategies also
vary greatly between published series. This lack of uniformity in the available literature has
rendered the establishment of evidence-based, reproducible protocols for the management of
tibial non-unions difficult.
Controversies regarding non-union definition and classification contribute to delays in treatment
and exacerbate the morbidity that is commonly associated with non-union development. In this
work we propose a new definition for non-union and introduced a novel concept of ‘potential
non-union’ to emphasise the importance of early recognition and referral.
The lack of reproducible, evidence-based treatment protocols, combined with the large volume
of tibial non-union cases managed in KwaZulu-Natal, South Africa, lead to the development of a
tibial non-union treatment algorithm. This algorithm was based on results from two retrospective
audits of patients with tibial non-unions who were managed with circular external fixators over a
four-year period. The algorithm classifies non-unions into four distinct groups, each with a
specific treatment strategy. These reports also introduced the concept of mechano-biology to the
management of tibial non-unions and were the first to use hexapod circular fixators for
distraction of stiff hypertrophic tibial non-unions. Subsequently a prospective interventional
study was undertaken aimed at evaluating the effectiveness of the proposed tibial non-union
treatment algorithm.
Description
Doctor of Philosophy in Orthopaedic Surgery.. University of KwaZulu-Natal, Medical School 2015.
Keywords
Tibia., Fracture fixation -- Complications., Fractures -- Treatment., Bone plates (Orthopedics), Theses -- Orthopaedic surgery., Tibial non-union treatment.