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[Pressure interlocking intramedullary nailing fixation and bone grafting for treatment of tibial fracture nonunion].

OBJECTIVE
To explore the curative effect of intramedullary nailing pressure within a fixed period with a bone graft taken from the opening of intramedullary nailing on tibial fracture nonunion.


METHODS
From February 2008 to October 2010, 18 patients with nonunion of tibial shaft were treated by pressurized intramedullary nail fixation and bone grafting taken from the opening of intramedullary nailing. They included 12 males and 6 females ranging in age from 31 to 67 (mean 42) years. The time from injury to surgery was 6-18 months (mean 8 months). There were 11 cases of nonunion and 7 cases of delayed union. After operation, the knee function was evaluated according to HSS scoring. The therapeutic effect was assessed by Tenny-Wiss scoring system.


RESULTS
All patients were followed up for 12-36 (mean 18) months. The wound healed well without infection or skin necrosis. All patients had no nonunion, infection, deformity, and re-fracture. The bone healing time was from 4 to 8 months (mean 6 months). The HHS score of knee function 1 year after surgery averaged (89.97 +/- 3.21). The effect result of Tenny and Wiss scoring system was excellent in 16 cases and good in 2 cases.


CONCLUSION
Open reduction by intramedullary nail fixed within a period with bone graft (from the opening of intramedullary nailing) for treatment of nonunion and delayed union of tibial fracture can improve the fracture healing rate, avoid complications from iliac bone grafting, and reduce medical expenses.