NONUNION OF THE TIBIA TREATED WITH A REAMED INTRAMEDULLARY NAIL

被引：43
作者：
WISS, DA
STETSON, WB
机构：
[1] Southern California Orthopaedic Institute, Van Nuys, CA, 91405-3730
[2] Department of Orthopedic Surgery, University of Southern California, Los Angeles, CA
来源：
JOURNAL OF ORTHOPAEDIC TRAUMA | 1994年 / 8卷 / 03期
关键词：
NONUNION; TIBIA; INTRAMEDULLARY NAIL;
D O I：
10.1097/00005131-199406000-00002
中图分类号：
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];
学科分类号：
摘要：
Forty-seven tibial nonunions were treated with a reamed intramedullary nail. Initially, there were 14 (30%) closed and 33 (70%) open tibial fractures. The initial fracture management consisted of casts in 12 (26%) patients, Ender or Lottes nails in nine (19%), and external fixation in 26 (55%). The time from injury to nailing averaged 31.5 weeks. All but one fracture was nailed using a closed technique (98%). Twenty-six patients were initially managed with external fixation. Duration of fixation averaged 11 weeks, and the time from fixator removal to nailing averaged 24 weeks. Patients were followed for an average of 18.7 months after nailing. Forty-two of the 47 (89%) nonunions united uneventfully. Infection developed in six (13%) patients, five of which occurred in previously open fractures treated with external fixation. After one or more procedures, these nonunions consolidated without apparent infection. Reamed intramedullary nailing is a safe and effective method of treatment for tibial nonunions of previously closed fractures and prior open fractures that have been treated with Ender or Lottes nails. Because of the risk of infection, we do not recommend its use after external fixation of open fractures.
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页码：189 / 194
页数：6
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共 23 条
  • [1] Blachut P.A., Meek R.N., O'Brien P.J., External fixation and delayed intramedullary nailing of open fractures of the tibial shaft, J Bone Joint Surg [Am], 72, pp. 729-735, (1990)
  • [2] Bohler J., Treatment of non-union of the tibia with closed and semiclosed intramedullary nailing, Clin Orthop, 43, pp. 93-101, (1965)
  • [3] Bone L.B., Johnson K.D., Treatment of tibial fractures by reaming and intramedullary nailing, J Bone Joint Surg [Am], 68, pp. 877-887, (1986)
  • [4] Christensen N.O., Küntscher intramedullary reaming and nail fixation for non-union of fracture of the femur and tibia, J Bone Joint Surg [Br], 55, pp. 312-318, (1973)
  • [5] Clancey G.J., Winquist R.A., Hansen S.T., Non-union of the tibia treated with Küntscher intramedullary nailing, Clin Orthop, 167, pp. 191-196, (1982)
  • [6] Danis R., Théorie Et Pratique De l’Ostéosynthése, (1949)
  • [7] Burrows H.J., Treatment of ununited fractures by bone grafting without resection of the bone ends, Proc R Soc Med, 33, (1940)
  • [8] Fischer M.D., Gustilo R.B., Varecka T.F., The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft tissue injury, J Bone Joint Surg [Am], 73, pp. 1316-1322, (1991)
  • [9] Galpin R.D., Veith R.G., Erson J.T., Treatment of failures after plating of tibial fractures, J Bone Joint Surg [Am], 68, pp. 1231-1236, (1986)
  • [10] Gustilo R.B., Mendoza R.M., Williams D.N., Problems in the management of type III (Severe) open fractures: A new classification of type III open fractures, J Trauma, 24, pp. 742-746, (1984)
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