Clinical reliability of closed techniques and comparison with open strategies to achieve union at the docking site

• Published in: International orthopaedics Vol. 36; no. 4; pp. 817 - 825
• Main Authors: Lovisetti, Giovanni, Sala, Francesco, Miller, Anna N., Thabet, Ahmed M., Zottola, Vincenzo, Capitani, Dario
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.04.2012
• Subjects: Adult; Aged; Bone Lengthening; Cost-Benefit Analysis; Female; Fracture Fixation, Internal - economics; Fracture Fixation, Internal - methods; Fracture Healing; Fractures, Ununited - therapy; Humans; Male; Manipulation, Orthopedic; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures; Original Paper; Orthopedics; Osteogenesis - physiology; Osteogenesis, Distraction - economics; Osteogenesis, Distraction - methods; Osteotomy; Reoperation; Reproducibility of Results; Retrospective Studies; Tibial Fractures - therapy; Young Adult; Docking Site; Simple Compression; Bone Transport; Closed Procedure; Intramedullary Nailing
• ISSN: 0341-2695; 1432-5195; 1432-5195
• DOI: 10.1007/s00264-011-1260-4

Purpose This retrospective review follows 31 tibial nonunions to compare union at the docking site using closed versus open strategies. In this cohort of patients, all but five were infected nonunions. Methods Thirteen patients initially treated with single compression were compared with 18 patients treated by open revision of the docking site. In the single compression group, an average of 6.5 cm of bone was resected and index lengthening was 2.04. In the open revision group, a mean of 9.4 cm was resected and the index lengthening was 1.73. Results Consolidation at the docking site occurred in all subjects in both groups. There was no statistical difference between the two groups. Conclusive evidence of superiority of one modality of treatment over the other cannot be drawn from our data. Conclusions The simple compression procedure requires less invasive surgery and is probably less demanding and more cost-effective in short transports.