Outcomes of Patients With Nonunion After Open Tibial Shaft Fractures With or Without Soft Tissue Coverage Procedures

Objectives: To evaluate the outcomes of patients who underwent soft tissue flap coverage during treatment of a tibia fracture nonunion. Design: Retrospective analysis on prospectively collected data. Setting: Academic medical center. Patients/Participants: One hundred fifty-seven patients were treated for a fracture nonunion after a tibia fracture over a 15-year period. Sixty-six patients had sustained an open tibial fracture initially and 25 of these patients underwent soft tissue flaps for their open tibia fracture nonunion. Intervention: Manipulation of soft tissue flaps, either placement or elevation for graft placement in ununited previously open tibial fractures. Main Outcome Measurements: Bony healing, time to union, ultimate soft tissue status, postoperative complications, and functional outcome scores using the Short Musculoskeletal Functional Assessment (SMFA). This group was compared with a group of open tibial fracture nonunions that did not undergo soft tissue transfer. Results: Bony healing was achieved in 24 of 25 patients (96.0%) who received flaps at a mean time to union of 8.7 +/- 3.3 months compared with 39 of 41 patients (95.1%) at a mean 7.5 +/- 3.2 months (P > 0.05) in the noncoverage group. Healing rate and time to union did not differ between groups. At latest follow-up, the flap coverage group reported a mean SMFA index of 17.1 compared with an SMFA index of 27.7 for the noncoverage group (P = 0.037). Conclusions: Utilization of soft tissue flaps in the setting of open tibia shaft nonunion repair surgery are associated with a high union rate (>90%). Coverage with or manipulation of soft tissue flaps did not result in improved bony healing rate or time to union compared with those who did not require flaps. However, soft tissue flap coverage was associated with higher functional scores at long-term follow-up.

Automated summary

The study evaluated the outcomes of patients with nonunion tibia fractures who underwent soft tissue flap coverage, finding a high union rate and better functional scores in the flap coverage group.