Surgical treatment and outcomes of extraarticular proximal tibial nonunions.

INTRODUCTION: Although malunion of proximal tibial metaphyseal fractures are not infrequent, nonunion of the proximal tibia is rare. These nonunions can present particular challenges in management, such as malalignment, a short proximal segment, and soft tissue compromise. Few treatment guidelines and long-term outcomes are available. The purpose of this study was to determine the long-term functional outcomes of patients treated with open reduction and internal fixation.

MATERIALS AND METHODS: Sixteen patients with a proximal tibial nonunion were treated between 1992 and 2005. Five fractures were originally open injuries, but all were aseptic at the time of definitive fixation. All nonunions were treated with a consistent approach of debridement, deformity correction, lateral plating, tensioning and compression, lag screws and bone grafting. Patients were reviewed radiographically and with a Knee Society questionnaire at a mean follow-up of 39 months (range 10-113 months).

RESULTS: All nonunions healed at an average of 4 months, and alignment was within 5 degrees of anatomic in all cases. Knee Society function and knee scores improved significantly, to 87.4 and 89.4, respectively (P < 0.05 for both). Functional outcomes were excellent overall. Fourteen of the patients (88%) subjectively returned to their previous activities and were satisfied with their result.

CONCLUSIONS: Using an algorithmic approach of débridement, deformity correction, lateral tension band plating with compression, and rigid stabilization, fracture healing and functional outcome can be reliably restored in these difficult fractures.