Distal tibia nonunion: success rate via survival posterolateral approach

BACKGROUND: Distal tibia nonunion often results from open fractures. Its surgical treatment can be challenging due to bone loss and surrounding tissue damage. The study aims to evaluate the long-term surgical and functional outcomes of patients suffering from nonunion, treated with either internal fixation or tibiofibular grafting through the posterolateral approach. METHODS: Between January 2013 and February 2018, we treated 21 patients affected with distal tibial nonunion through the posterolateral approach first described in 1945 by Harmon and modified by Tornetta, in a 2nd level trauma center. The follow-up lasted 41.28 months and evaluated clinical and radiological results retrospectively. The primary outcome evaluated nonunion consolidation and secondary outcomes verified symptoms and ability to function using AOFAS index and VAS. Complications were monitored and reported. RESULTS: Healing rate using the posterolateral approach reached 76.2%, the mean consolidation occurred at 5.6 months. AOFAS Index averaged 74 and VAS scored 30 for pain, 90 for treatment satisfaction and 70 for ability to work. CONCLUSIONS: Our data suggest that non-infected distal tibial nonunion can be successfully treated in a substantial share of patients by internal fixation or tibia-pro-fibula grafting through the posterolateral approach. This treatment allows consolidation, increases the patients’ ability to work and reduces pain leading to a better quality of life on the long-term.