Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation

Background: Tibial nonunions pose significant treatment challenges despite the regularity with which they are encountered. While several studies have reported the outcome of treating different nonunion subtypes with various strategies, few have investigated the factors that influence treatment and o...

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Main Authors: Nando Ferreira, Leonard Charles Marais, Tonya M Esterhuizen
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2017-01-01
Series:Journal of Limb Lengthening & Reconstruction
Subjects:
Online Access:http://www.jlimblengthrecon.org/article.asp?issn=2455-3719;year=2017;volume=3;issue=1;spage=31;epage=36;aulast=Ferreira
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author Nando Ferreira
Leonard Charles Marais
Tonya M Esterhuizen
author_facet Nando Ferreira
Leonard Charles Marais
Tonya M Esterhuizen
author_sort Nando Ferreira
collection DOAJ
description Background: Tibial nonunions pose significant treatment challenges despite the regularity with which they are encountered. While several studies have reported the outcome of treating different nonunion subtypes with various strategies, few have investigated the factors that influence treatment and outcome. Aims: This study aims to identify factors that complicate the management of uninfected tibial nonunions and are associated with failure of treatment. Materials and Methods: We retrospectively reviewed all patients with uninfected tibial nonunions who were treated according to a standardized treatment algorithm over a 5-year period. Results: The final cohort consisted of 84 patients with a mean age of 36.5 years (range 5–68 years). Bony union was achieved in 79 out of 84 (94%) tibias. Malalignment (P < 0.001), smoking (P = 0.008), alcohol use (P = 0.039), and time from injury to nonunion management (P = 0.003) were found to be associated with treatment failure. The factors found to be associated with increased treatment complexity were smoking (P = 0.035), alcohol use (P = 0.011), and time from injury to nonunion management (P < 0.001). Conclusion: General orthopedic surgeons should, therefore, refer these patients to reconstructive surgeons as soon as the diagnosis of a tibial nonunion is made while reconstructive surgeons should note the importance of host optimization and mechanical alignment during the management of these conditions.
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spelling doaj.art-94a745ed0d5f4756b735b6fd21493e382022-12-21T18:53:46ZengWolters Kluwer Medknow PublicationsJournal of Limb Lengthening & Reconstruction2455-37192455-37192017-01-0131313610.4103/jllr.jllr_24_16Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixationNando FerreiraLeonard Charles MaraisTonya M EsterhuizenBackground: Tibial nonunions pose significant treatment challenges despite the regularity with which they are encountered. While several studies have reported the outcome of treating different nonunion subtypes with various strategies, few have investigated the factors that influence treatment and outcome. Aims: This study aims to identify factors that complicate the management of uninfected tibial nonunions and are associated with failure of treatment. Materials and Methods: We retrospectively reviewed all patients with uninfected tibial nonunions who were treated according to a standardized treatment algorithm over a 5-year period. Results: The final cohort consisted of 84 patients with a mean age of 36.5 years (range 5–68 years). Bony union was achieved in 79 out of 84 (94%) tibias. Malalignment (P < 0.001), smoking (P = 0.008), alcohol use (P = 0.039), and time from injury to nonunion management (P = 0.003) were found to be associated with treatment failure. The factors found to be associated with increased treatment complexity were smoking (P = 0.035), alcohol use (P = 0.011), and time from injury to nonunion management (P < 0.001). Conclusion: General orthopedic surgeons should, therefore, refer these patients to reconstructive surgeons as soon as the diagnosis of a tibial nonunion is made while reconstructive surgeons should note the importance of host optimization and mechanical alignment during the management of these conditions.http://www.jlimblengthrecon.org/article.asp?issn=2455-3719;year=2017;volume=3;issue=1;spage=31;epage=36;aulast=FerreiraIlizarovnonunionoutcometibiatreatment
spellingShingle Nando Ferreira
Leonard Charles Marais
Tonya M Esterhuizen
Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation
Journal of Limb Lengthening & Reconstruction
Ilizarov
nonunion
outcome
tibia
treatment
title Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation
title_full Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation
title_fullStr Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation
title_full_unstemmed Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation
title_short Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation
title_sort factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation
topic Ilizarov
nonunion
outcome
tibia
treatment
url http://www.jlimblengthrecon.org/article.asp?issn=2455-3719;year=2017;volume=3;issue=1;spage=31;epage=36;aulast=Ferreira
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AT tonyamesterhuizen factorsassociatedwithtreatmentfailureofaseptictibialnonunionsmanagedbycircularexternalfixation