[Delayed union and pseudarthrosis of the long bone].
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Despite modern treatments of tibial fractures, we still have nonunions. In case of failure we used a method of treatment which has become less popular over the last decades. A rectangular inlay graft is harvested from the anteromedial tibial surface. The graft, measuring about 12 to 15 cm long, is placed over the nonunion with 2/3 of its length on one side and the remaining third on the other side. The graft is turned 180 degrees and fixed with four lag screws in the original donor site. Postoperatively, we place a nonweight-bearing cast for 3 months. The results are quite satisfactory for both nonunions and difficult multi-operated nonunions.
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We report our first experience of using the Ilisarov technique in the treatment of ten patients with aseptic nonunions of fractures. In nine cases there was a nonunion of the tibia. One 76-year-old woman suffered from a nonunion of a supracondylar fracture of the humerus with concomitant rheumatoid arthritis. In this case, treatment failed. In two other cases we had to change the procedure. The mean duration of fixation for the successful cases was 22 weeks. The Ilisarov technique is sophisticated and needs special experience but has advantages in difficult cases.
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