Locking screw augmentation in hypertrophic nonunion of tibia: a novel surgical technique

BACKGROUND AND AIM: Nonunion is a common complication in long bone diaphyseal fracture. Hypertrophic nonunion is commonly caused by mechanical instability due to high strain at the fracture site whereas atrophic nonunion is mainly caused by biological impairment. We present our surgical option in hypertrophic nonunion of lower limb. METHODS: We reported a 45-year-old man clinical case, complaining of pain localized to the left ankle after a high-energy trauma. He reported a distal meta-diaphyseal tibial fracture associated to the fracture of the fibula, surgically treated with open reduction and internal fixation with a medial bridge plate for the tibia, and distal plate for the fibula. After surgery, radiographic monitoring showed a poor progression in the consolidation process. At seven months, CT scan confirmed a Hypertrophic nonunion (HN) of the tibia. We decided to maintain the previous hardware and to gain more stability adding a locking screw in the metadiaphyseal region. RESULTS: Radiographic evaluations carried out three months after surgery showed that the fracture line was radiographically filled by bone callus. No pain, no limp, no signs of infection or implant failure were reported. CONCLUSIONS: Locking screw augmentation could represent a valid technique to reduce micromovements and to increase the stability at the fracture site with the possibility of early weight bearing and good clinical outcome. (www.actabiomedica.it)