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Atrophic, aseptic, tibial nonunion: how effective is modified Judet’s osteoperiosteal decortication technique and buttress plating?

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tibial nonunion is the most common nonunion encountered by the orthopedic surgeon. Repeated surgeries, cost, increased duration of hospital stay, disability, pain all contribute to the increased morbidity. Many methods have been used to treat nonunion of tibia with variable results and none of them are 100 % successful. Our objective was to determine the effectiveness of modification of Judet’s decortication technique and buttress plating, without bone graft, in the treatment of aseptic, atrophic tibial nonunion. Also, to find the correlation between time of achieving union and time since injury to decortication.

Materials and methods

Ours is a retrospective study conducted at a Level I trauma center. A total of 35 cases of atrophic tibial nonunion, irrespective of the cause, was treated by modifying Judet’s osteoperiosteal decortication and plating during the time period January 2006 to July 2013. Demographic data, range of motion, time of achieving union and clinico-radiological evaluation for union of fracture were included as main outcome measurements.

Results

Union was achieved in all cases with a mean duration of 8.34 months. Pain and stiffness of joints were not reported in any case on long-term follow-up and the patients had satisfactory range of motion. Implant removal was done in three cases after fracture union.

Conclusion

Treatment of atrophic tibial nonunion is challenging and management of each nonunion has to be customized based on the biological and mechanical characteristics of the nonunion. Plating with osteoperiosteal decortication is an effective and simple technique, which in our hands has shown to result in 100 % union rates without the need of additional bone healing augmentation procedures like bone grafting.

Level of evidence

Level II.

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Authors and Affiliations

  1. Department of Orthopedics, Grande International Hospital, Kathmandu, Nepal

    Bijukachhe Binod, Singh Nagmani, Bhandari Bigyan & Adhikari Prashant

  2. Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    John Rakesh

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  1. Bijukachhe Binod
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  2. Singh Nagmani
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  3. Bhandari Bigyan
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  4. John Rakesh
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  5. Adhikari Prashant
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Correspondence to Singh Nagmani.

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All the authors declare that there is no conflict of interest and no grant was acquired for any part of the study.

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Binod, B., Nagmani, S., Bigyan, B. et al. Atrophic, aseptic, tibial nonunion: how effective is modified Judet’s osteoperiosteal decortication technique and buttress plating?. Arch Orthop Trauma Surg 136, 1069–1076 (2016). https://doi.org/10.1007/s00402-016-2488-7

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  • DOI: https://doi.org/10.1007/s00402-016-2488-7

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