Nonunion: Tibia Case

Presenting

This x-ray shows a nonunion in the tibia of a 12 year old boy 6 months after an open fracture treated by other physicians elsewhere using external fixation. He developed an infection of the bone and soft tissues and had 5 different surgeries to treat the infection. When he was referred to Dr. Brinker's office, he had no signs of infection, but the bone appeared to have a poor blood supply and the bone fragments were separated from one another. He had moderate pain, was unable to bear weight on that leg, and required crutches to walk.

Result After Treatment by Dr. Brinker

This x-ray taken 12 weeks after surgical treatment with a plate and bone grafting shows that the bone is solidly healed. He has no pain and is able to walk and run without any problems.

Presenting

This 70 year old man who has diabetes fractured his ankle. When he was referred to Dr. Brinker's office 10 months after his injury and treatment with a plate at an outside facility by other physicians, the bone was infected, crooked, and had no signs of healing. The patient had severe pain and was confined to a wheelchair. His care was complicated by the fact he had previously had a total knee replacement on the same side

Treatment in Progress

These x-rays taken after surgery to remove the infected bone and during treatment with Ilizarov deformity correction followed by compression show the gradual straightening of the bone and compression of the nonunion site to stimulate healing.

Result After Treatment by Dr. Brinker

These x-rays taken after Ilizarov treatment show a straight and solidly healed bone. The patient had no pain and was able to walk and do his normal activities without assistance.

Presenting

This 60 year old man was referred in with a nonunion of his tibia following treatment with external fixation for an open fracture at an outside facility by other physicians. At the time of referral, the bone was infected, highly fragmented, and showed no signs of healing. The patient had constant severe pain and was confined to a wheelchair.

Treatment in Progress

This series of x-rays shows treatment using Ilizarov bone transport. A large segment of infected bone in the upper tibia had been removed. The lower tibia had been split into two segments, and these segments were slowly moved upward using the llizarov external fixator until the bone was restored.

Result After Treatment by Dr. Brinker

These images taken after Ilizarov treatment show a solid bone with length completely restored. The patient has no pain, no sign of infection and can participate in all of his usual activities without assistance.

Presenting

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.

Result After Treatment by Dr. Brinker

Following slow gradual compression the patient’s tibial nonunion healed rapidly. The external fixator was removed three months after application and the patient returned to full pain free activity.

Presenting

This 44-year-old police officer was directing traffic when a car traveling at 60 miles per hour ran him over. The patient sustained severe fractures to both tibias that were initially treated at an outside facility with intramedullary nail fixation.

The patient failed to unite his right tibia and was referred to Dr. Brinker for continued care. Initial visit X-rays of the right tibia show that both the upper and lower fracture sites had failed to heal (a segmental tibial nonunion). The patient had severe pain and was unable to walk.

Results After Treatment by Dr. Brinker

This gentleman was treated with exchange nailing and his tibia healed rapidly at both nonunion sites. At follow-up he is free of pain and walks without ambulatory aides.

Presenting

This 51 year old woman sustained a left open distal tibia fracture while weightlifting. The wound was grossly contaminated. Following irrigation and debridement her fracture was treated with intramedullary nail fixation by her treating orthopedic surgeon at an outside facility. In addition, her segmental fibula fracture had been treated by plate and screw fixation.

Because of slow healing her treating physician tried another surgical method to promote healing of her fracture. When this treatment and an external bone stimulator failed to result in success the patient was referred in to see Dr. Brinker.

Result After Treatment by Dr. Brinker

Following exchange nailing the patient’s tibia healed rapidly and her severe pain completely resolved. A second procedure, plate and screw fixation and bone grafting, was later performed to bring the fibula nonunion to successful bony union.