Internal fixation through posterolateral approach versus Ilizarov external fixation for treatment of aseptic distal tibia nonunion: a comparative analysis.

Abstract

Purpose: Distal tibia nonunion poses a serious therapeutic challenge for orthopedic surgeons. Bone loss and soft tissue damage is relatively common. The aim of this study was to compare the healing rate and related functional outcomes between two retrospective series of distal tibia nonunion cases treated with internal fixation via the posterolateral approach and those managed with Ilizarov external fixation.

Methods: This retrospective cohort study included 47 affected by distal tibia nonunion. The subjects had undergone internal fixation with inter-tibiofibular graft through the posterolateral approach (Group A, n = 24) and Ilizarov method associated or not with bone transport procedures and osteotomies (Group B, n = 23). Results were assessed at a minimum 24 months after surgery. Consolidation rate, radiographic healing time of nonunion, the American Orthopedic Foot and Ankle Society (AOFAS), the short form health survey (SF-12) and Visual Analog Scale (VAS) scores (pain, ability to work and treatment satisfaction) were compared between the groups. Complications and reoperations were also recorded.

Results: The nonunion healing rate was 75% (18/24) in the group A and 91% in the group B (21/23)(p = 0.001). Consolidation was observed, on average, 5.7 months after surgery (range, 4-9) in the group A and 10.7 months in the B group (range, 5-24) (p = 0.001). All patients recovered have had good functional outcomes with no significant differences between the groups. At final follow-up, AOFAS scores in the A group were 74 (range 52-94), while in the B group it was 79 (range 57-100). Group A showed a better perception of mental health status (SF-12-MCS 46 vs. 45, p = 0.36) and a better satisfaction with the treatment received, but a worse perception of their physical health status (SF-12-PCS 49 vs. 50, p = 0.52) with a lower mean score on working ability.

Conclusion: Distal tibial nonunion can be successfully treated with the posterolateral approach, or external Ilizarov fixation. There are not significative outcomes differences when patients undergoing internal or external fixation. Although healing times are faster with internal fixation via the posterolateral approach, healing rates are higher with the Ilizarov method.