ArticleInternational orthopaedics2017
Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions.
Article in International orthopaedics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis.Journal of orthopaedic surgery and research · 2020Pooled it
- The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2022Trial
- Extra-Articular Distal Tibia Non-Union Treated With Ipsilateral Fibular Strut Graft with Implants In Situ - A Case Report.Journal of orthopaedic case reports · 2026Article
- Distal tibial nail for complex nonunion of open distal tibial fracture with diabetes and prior pin-site infection: A case report.International journal of surgery case reports · 2025Article
- Surgical treatment of distal tibia non-unions with a retrograde intramedullary nail as a therapy option to prevent amputation.Scientific reports · 2025Article
- Ultra-distal tibial fractures: a retrospective comparison of distal plate versus nail fixation.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025Article
- Nonunion of the distal one-fourth of the tibia treated by retrograde tibial intramedullary nail.The Journal of international medical research · 2024Article
- Article
- A preclinical large-animal model for the assessment of critical-size load-bearing bone defect reconstruction.Nature protocols · 2020Article
- High-energy tibial pilon fractures: an instructional review.International orthopaedics · 2019Review
- Treatment of distal tibial fractures: prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome.International orthopaedics · 2019Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe purpose of this study was to examine time to union of extra-articular distal tibia nonunions based on fracture type and fixation methods: intramedullary nail (IMN), plate osteosynthesis (PO), and external fixation (EF).
methodsThis retrospective chart review included all patients who presented at a Level I trauma center with AO/OTA 43A & distal third 42A-C fracture nonunions between 2008 and 2014. Fixation methods were recorded and patient course was followed until nonunion had healed clinically.
resultsThirty-three distal tibia nonunions were included, and 29 reached eventual union (88%). Five AO/OTA fracture types were present. Mean times to union from nonunion diagnosis between original fracture types were compared (p = 0.203). Comminuted fracture types had longer times to union from nonunion diagnosis compared to simple fracture types (78 vs. 46 weeks, p = 0.051) and more revision fixations (1.5 vs. 0.5, p = 0.037). Mean time to union from nonunion diagnosis was shorter when no revision fixation was done compared to revisions (15 vs. 42 weeks, p = 0.102). Times to union from nonunion diagnosis without revision fixation were: IMN (12 weeks), PO (27 weeks), and EF (13 weeks) (p = 0.202). Times to union from definitive revision fixation were: IMN (17 weeks), PO (21 weeks), and EF (66 weeks) (p = 0.009), with EF taking significantly longer than both other methods. 21 patients (64%) underwent revision fixation. Revision fail rates were: IMN (0/6, 0%), PO (2/8, 25%), and EF (15/21, 71%). Time to union was longer in revisions that changed fixation method compared to revisions that used the same method (51 vs. 18 weeks, p = 0.030). Deep infections were also associated with longer union times (81 vs. 47 weeks, p = 0.040).
conclusionsIn this nonunion population, comminuted fracture types needed more time and revisions to reach union. Time to union was only clinically shorter when revision fixation was not performed, but IMN and PO were both successful fixation options with significantly shorter times to union than EF. Mean time to union increased even more when revision of fixation method was performed vs. exchange revision, as did nonunions with deep infections.
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