Proximal Tibia Non-Union: A Case Report and Review of Literature

Abstract

Fractures of proximal tibia are common yet serious injuries, if not treated well, it results in significant functional impairment. The treatment of metaphyseal nonunions can be particularly difficult, and may present unique issues compared to diaphyseal nonunions. The first main variable the surgeon needs to consider is whether the nonunion site is capable of a biologic response. While the biologic capability is usually preserved in metaphyseal bone, severe osteopenia may exist due to prolonged immobilization or limited weight bearing. The soft tissue envelope may be compromised due to traumatic devascularization or chronic infection. Both of these factors may act to devitalize a short periarticular fragment and may make stable internal fixation difficult. Locking periarticular plates for the proximal tibia may be advantageous for achieving implant stability and restoring anatomic alignment. We present you a case of 11 months old operated Schatzker type 6 right proximal tibia non-union treated with fibrous tissue excision, freshening of fracture site, cancellous bone grafting and open reduction internal fixation with plating and encirclage wiring with fibulectomy.