Pediatric aseptic lower leg fracture nonunion
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ORIGINAL ARTICLE
Pediatric aseptic lower leg fracture nonunion Christian von Rüden1,2,3 · Sven‑Oliver Dietz4 · Peter Schmittenbecher5 · Francisco F. Fernandez6 · Justus Lieber7 · Björn Wilkens8 · Matthias Rüger9 · Dorien Schneidmueller1 Received: 21 September 2020 / Accepted: 10 November 2020 © The Author(s) 2020
Abstract Purpose Lower leg nonunion in pediatric patients is a rarity. Therefore, eight European pediatric trauma units retrospectively analyzed all patients younger than 18 years suffering lower leg fractures resulting in aseptic nonunion. Methods Thirteen children and adolescents less than 18 years old (2 girls and 11 boys) diagnosed with aseptic nonunion of the tibia and/or fibula were evaluated. In all patients, epidemiological data, mechanism of injury, fracture configuration, and the initial treatment concept were assessed, and the entire medical case documentation was observed. Furthermore, potential causes of nonunion development were evaluated. Results The mean age of patients was 12.3 years with the youngest patient being seven and the oldest being 17 years old. Open fractures were found in six out of thirteen patients (46%). Nonunion was hypertrophic in ten and oligotrophic in three patients. Mean range of time to nonunion occurrence was 7.3 ± 4.6 months. Nonunion healing resulting in complete metal removal was found in 12 out of 13 patients (92%), only in one case of a misinterpreted CPT type II osseous consolidation could not be found during the observation period. Mean range of time between surgical nonunion revision and osseous healing was 7.3 months as well. Conclusion If treatment principles of the growing skeleton are followed consistently, aseptic nonunion of the lower leg remains a rare complication in children and adolescents. Factors influencing the risk of fracture nonunion development include patient’s age, extended soft tissue damage, relevant bone loss, and inadequate initial treatment. Keywords Nonunion · Pseudarthrosis · Lower leg · Tibia · Fibula · Pediatric · Children · Adolescents
Introduction Fracture nonunion is difficult to treat and represents a chal‑ lenge for the treating surgeon as well as it is a physical and psychological burden for the young patient. There is a general consensus that regardless of patients’ age, fracture
* Christian von Rüden christian.vonrueden@bgu‑murnau.de 1
Department of Trauma Surgery, BG Unfallklinik Murnau, Professor Küntscher Str. 8, 82418 Murnau, Germany
2
Department of Trauma Surgery, Sports Orthopaedics and Pediatric Traumatology, Klinikum Garmisch‑Partenkirchen, Garmisch‑Partenkirchen, Germany
3
Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
4
Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
healing depends on a number of factors such as the complex‑ ity of the fracture, blood supply to the fracture site, bone stability, existing inflammation and existing preconditions [1–3]. The management of fracture nonunion i
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