Publication:

Continuous external compression with a dynamic axial fixator in the treatment of tibial nonunions: a single-center experience

Background Tibial nonunion remains a therapeutic challenge for orthopedic surgeons, particularly when associated with poor soft-tissue condition, bone defects, infection, or deformity. Continuous external compression with a dynamic axial fixator offers a biological and mechanical solution without the need for bone grafting. We report our single-center experience using this method.

Methods We retrospectively reviewed 20 patients (mean age 39 years) with tibial nonunions treated between 2012 and 2017. The mean time from injury to treatment was 21.6 months. Eight cases were septic and received culture-specific antibiotics; no debridement was performed. One case with a 4 cm defect underwent corticotomy and bone transport, while the remaining patients were managed with acute compression only. Outcomes were evaluated clinically and radiographically using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.

Results Bone union was achieved in all patients (100%). The mean time to union was 3.5 months. Nineteen patients were treated with compression alone, and one with lengthening followed by compression. No bone grafting was required. Bone results were excellent in 17 cases and good in 3. Functional results were excellent in 12 and good in 8. No poor outcomes were recorded. The main complication was pin-tract infection (20%).

Conclusions Continuous external compression with a dynamic axial fixator is an effective method for the treatment of tibial nonunions, both septic and aseptic, and can achieve union without bone grafting even in the presence of bone loss.