Malunion of the Tibia: A Systematic Review

Abstract

Background and Objectives: Tibial malunions are defined as tibial fractures that have healed in a clinically unacceptable position, resulting in deformity such as shortening, lengthening, abnormal rotation, or angulation. These deformities can have adverse effects on patients, such as pain and gait disturbance, as well as long term development of post-traumatic arthritis. This paper seeks to highlight some of the options for surgical management of malunions and detail the strategies and approaches used to manage these complicated cases. Materials and Methods: An exhaustive search was conducted on PubMed using the key search terms “Tibial” OR “Tibia” AND “Malunion” to be included in the title. Exclusions to the search included any article with patients aged < 18 years, any nonhuman subjects, and any article not published or translated into English. Results: A systematic review of the literature revealed 26 articles encompassing 242 patients who had undergone surgical correction for tibia malunion. A total of 19 patients suffered from complications. Methods of treatment included osteotomies, with plate and screws, external fixator, angled blade plate, intramedullary nails, Ilizarov fixator, Taylor Spatial Frame, Precise nail, and total knee arthroplasty. Restoring alignment and the articular surface led to overwhelmingly positive patient outcomes. Conclusions: Tibial malunions take many forms, and as such, there are many approaches to correcting deformities. The literature supports the following radiological parameters to diagnose tibial malunion: 5–10 degrees angulation, 1–2 cm shortening, 10–15 degrees internal rotation, and 10–20 degrees external rotation. Surgical plans should be customized to each individual patient, as there are many approaches to tibial malunion that have been shown to be successful in delivering excellent clinical outcomes.

Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures?

“…The acceptable range of fracture reduction alignment is generally evaluated by length, angulation, and rotation [ 8 , 9 ]. For a tibia fracture, 10–20 mm shortening, 5–10° angulation, and 10–20° rotation are considered to be acceptable [ 10 ]. Tibial malunion occurs in 3–50% of conservative treatment and up to 20% of surgical fixation [ 10 ].…”

“…For a tibia fracture, 10–20 mm shortening, 5–10° angulation, and 10–20° rotation are considered to be acceptable [ 10 ]. Tibial malunion occurs in 3–50% of conservative treatment and up to 20% of surgical fixation [ 10 ]. Although plate osteosynthesis has the lowest malunion rate for tibial fractures [ 11 , 12 , 13 ], the malunion rate reaches up to 8.3% even after tibial plating [ 14 ], and midshaft fractures do not have a lower malunion rate than distal fractures [ 15 ].…”

Mathematically Directed Single-Cut Osteotomy

“…Long bone malunions have a reported incidence of up to 68% with casting/functional bracing and as high as 20% with intramedullary nailing [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Although malunions can have variable radiographic and functional outcomes, deformity correction is generally recommended for patients with a high risk of degenerative joint osteoarthritis, a painful deformity, or an unacceptable appearance [ 22 ]. Deformity correction, including leg length discrepancy, can be treated in several different ways.…”

“…Inclusive of congenital etiologies, long bone deformities cause pathologic biomechanical forces that can lead to accelerated radiographic and clinical arthritis [ 17 , 18 , 19 , 20 , 21 ]. In general, surgical correction of long bone deformities is recommended in patients with an increased risk of degenerative joint osteoarthritis and for a deformity that causes pain or an unacceptable appearance [ 22 ].…”

Effect of matrix material property on the composite tibia fracture plate: a biomechanical study

“…It can happen after surgery due to poor bone stabilization. Locked intramedullary (IM) and External Fixation are the most popular bone stabilization methods [4,5]. Another study found no difference in 6-and 12-month reoperation rates.…”