DOCKING POINT NON-UNION TREATED WITH INTRAMEDULLARY NAILING: A RETROSPECTIVE STUDY

G. Martin¹, G. Conza² , N. Garofalo², N. Di Cristofaro², M. Macera³, G. Iodice², Gi. Toro⁴, A. Braile⁵ , G. Toro²

¹ Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Napoli, Italy
² Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Napoli, Italy
³ Unit of Infectious Disease, AOU Vanvitelli, Napoli, Italy
⁴ Unit of Radiology, San Paolo Hospital, Napoli, Italy
⁵ Unit of Orthopaedics and Traumatology, Ospedale Del Mare, Napoli, Italy

Correspondence to:

Journal of Orthopedics 2022 Sep-Dec; 14(3): 102-107
https://doi.org/10.69149/orthopedics/2022v14iss3_3

Received: 13 September 2022 Accepted: 20 October 2022

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Abstract

Fracture septic nonunion is one of the most demanding complications for both the orthopedic surgeon and the patient, considering the need for several procedures that significantly impact patients’ quality of life. Very often, fracture septic nonunion is associated with bone loss. External fixation through the Ilizarov principles promotes the filling of the bone gap thanks to distraction osteogenesis, a technique also known as bone transport. However, fibrous tissue frequently appears during the bone transport at the lower end, leading to a docking point nonunion. This study aimed to evaluate the outcomes of patients presenting with docking point nonunion treated using intramedullary nailing. We conducted a retrospective study on those patients treated with bone transport who developed docking point nonunion and treated with intramedullary nailing. For each patient, we collected demographic data, prior diagnosis, time to heal the initial injury, ASA score, and other recalcitrant lower limb discrepancies and malalignments. Specific questionnaires, including the Oxford Knee Score, Oxford Hip Score, AOFAS Foot Score, and ASAMI Scoring System, were used to evaluate the functionality of the affected limbs. This study included 8 patients (6 males and 2 females), aged between 23 and 65 years. Seven patients had a diagnosis of a tibial nonunion, and one had a femoral nonunion. Radiographically, all patients had a gap with an average length of 5.03 cm (range 2.14-10.1 cm). At the final follow-up, all patients showed difficulty walking on uneven surfaces but not on flat surfaces. All patients had limb length discrepancies, with an average of 1.5 cm (range from 0.5 to 3.5 cm). Five out of 8 patients presented with a slight malalignment: 3 in valgus and 2 in varus, with an average deviation of 5.8° (range 5-11°). The use of the Ilizarov bone transport, followed by intramedullary nailing, is effective in recovering bone loss and achieving complete healing of the docking point in a relatively short time. This approach is associated with a low incidence of post-traumatic deformities and preservation of limb functionality within a relatively short period.

Keywords: bone loss, fracture, non-union, Oxford Hip Score, Oxford Knee Score, septic, tibia