| Objectives:Analysis the causes of tibial nonunion after fracture,and explore the Clinical effect of Post-intervention with external fixator to treate bone delayed union and tibial nonunion caused by tibial open fracture .Methods:24 bone delayed union and tibial nonunion patients caused by tibial open fracture who were first treated with external fixator in The Third Hospital of Hebei Medical University were retrospectively reviewed and analysed ,from January 2008 to February 2011. There were 22 males and 2 females with an average of 35.5 years old(17 to 70 years old) of them,including 6 cases of bone delayed union and 18 tibial nonunion patients.The shortest tibial nonunion were 3 months and the longest were 4 years with the average time of 8.1 months.The classification of open fractures according to Gustilo-Anderson type,24 tibial open fractures Including 3 cases of type I, lI type in 7 cases, IIIA 11 cases, IIIB in 2 cases, IIIC 1 case; According to morphological classification of fracture ,there were 4 cases of transverse fracture,10 case of wedge fracture, 10 case of comminuted fracture including 4 cases of tibial bone defect in 24 cases of tibial nonunion; By Weberh-Cech[1] on the classification of nonunion, the hypertrophic (vascular-rich) were 2 cases and atrophic (ischemic type) were 16 cases.For open wounds have been healed without bone defects in patients with bone delayed union,loose fixation knob above the fracture site can make the external fixator slide up and down along the knob so that the fracture stress and stimulation can be generated in walking;About the open wounds have been healed with little bone defects of atrophic nonunion patients,take some cancellous bone from iliac and plant it to the bone defect area after adjusted the leg length and the axis line of force with external fixator .when there is callus pass through the fracture site,loose the external fixation tune timely to promote fracture healing; For more bone defect atrophic nonunion patients,we use the exteral fixator which can regulate pressure and cut bone at upper tibial at the same time,and then make the twoends of bone defects close to each other at the rate of 1mm per day until the osteotomy and bone defects healing;To hypertrophic nonunion patients of open wounds have been healing ,we increase the strength of external fixator to achieve the fracture strong fixation.Results:The group of 6 bone delayed union patients without bone defects after walking 3 months with loosen external fixation can be seen much callus form; 2 cases of hypertrophic nonunion patients can be seen continuous callus pass through fracture site at 3 months later after enhance fixation strength of external fixation;there were callus formed 1.5 months later after cancellous bone grafting in 12 cases of little bone defects patients and for the 4 cases of large bone defects patients ,fracture fragments exposure to each other after surgery 8 months ,and we see callus formed at the position of osteotomy and bone defect.Conclusion:1 Tibial open fracture easily lead to delayed union and nonunion after operation2 Correctly use external fixation can prevent and treat tibial delayed union and nonunion after operation caused by open fractures3 The type and extent of fracture has a great influence on fracture healing4 External fixation can be regard as the final treatment of tibial open fracture,and avoid the pain of patients changing internal fixation...
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