Continuous external compression with a dynamic axial fixator in the treatment of tibial nonunions: a single-center experience

Med A. Rekik; Amin Moalla; Tarek Bardaa; Sami Sallemi; Hassib Keskes

doi:10.18203/issn.2455-4510.IntJResOrthop20261202

Authors

Med A. Rekik Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, University of Sfax, Tunisia
Amin Moalla Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, University of Sfax, Tunisia
Tarek Bardaa Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, University of Sfax, Tunisia
Sami Sallemi Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, University of Sfax, Tunisia
Hassib Keskes Department of Orthopedic Surgery and Traumatology, Habib Bourguiba University Hospital, University of Sfax, Tunisia

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261202

Keywords:

External fixation, Continuous compression, Dynamic axial fixator, Bone healing, Tibial non-union

Abstract

Background: Tibial nonunion remains a therapeutic challenge for orthopedic surgeons, particularly when associated with poor soft-tissue condition, bone defects, infection, or deformity. Continuous external compression with a dynamic axial fixator offers a biological and mechanical solution without the need for bone grafting. We report our single-center experience using this method.

Methods: We retrospectively reviewed 20 patients (mean age 39 years) with tibial nonunions treated between 2012 and 2017. The mean time from injury to treatment was 21.6 months. Eight cases were septic and received culture-specific antibiotics; no debridement was performed. One case with a 4 cm defect underwent corticotomy and bone transport, while the remaining patients were managed with acute compression only. Outcomes were evaluated clinically and radiographically using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.

Results: Bone union was achieved in all patients (100%). The mean time to union was 3.5 months. Nineteen patients were treated with compression alone, and one with lengthening followed by compression. No bone grafting was required. Bone results were excellent in 17 cases and good in 3. Functional results were excellent in 12 and good in 8. No poor outcomes were recorded. The main complication was pin-tract infection (20%).

Conclusions: Continuous external compression with a dynamic axial fixator is an effective method for the treatment of tibial nonunions, both septic and aseptic, and can achieve union without bone grafting even in the presence of bone loss.

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