Treatment of noninfectious nonunion of tubular fractures with compression-distraction-compression technique by external fixators

Objective To treat noninfectious nonunion of tubular fractures with compres-sion-distraction-compression technique by external fixators without grafting. Methods Form March 2007 to July 2009, 5 cases of noninfectious nonunion (involving 4 femurs and one tibiofibula) were stabilized by external fixators with a distraction device. Nonunians were compressed for 2 weeks, followed by distraction of one mm per day divided by 4 times until. A separation of 10 to 14 mm was achieved. The maximal distraction was maintained for 2 weeks before shortening with the same speed and rhythm was performed until the second com-pression. Next the nonunion site was compressed till union if osteogenic activity was present radiographically. One or two more cycles of compression-distractian were needed until union in cases of poor osteogenie response. Results Pin-tract infection and loosening happened in the tibiofibular nonunion and led to malapposition. Varns and reeurvatum deformities were present in a femoral nonunion at the time of the second compression. No other complications were noticed in other cases except pin tract problems. All 5 nonunions healed with an average healing time of 7.6 (6 to 10) months. Follow-ups for an average of 5.8 (1 to 10) months after fixator removal revealed no refracture. Conclusions Compression-distraction with external fixator is useful for noninfectious nonunions of tubular fractures. It can also decrease hemorrhage and soft tissue stripping during operation because it does not necessitate grafting. This technique may be indicated for those with no obvious leg length discrepancy, good contact area and optimal configuration for efficient compression. Key words: Fractures, ununited; External fixators; Femur, Tibia