Nonunion: Tibia Case 4

This 28 year old woman sustained a right tibia fracture as the result of a high energy motor vehicle collision. The patient’s fracture was treated at an outside facility by other physicians with intramedullary nail fixation. Two months later the patient developed an abcess and required operative intervention and intravenous antibiotics.

Seven months following the injury the patient presented to our institution with a painful hypertrophic nonunion of the tibia.

Treatment in Progress

Following nail removal, the patient received Ilizarov treatment by Dr. Brinker with slow distraction of her hypertrophic nonunion. Exchange nailing was discussed as an option but it was felt that her small medullary canal was poorly suited for this technique. Compression plating was also contemplated but the patient’s history of infection and the poor status of the soft tissues in the zone of injury were of concern.