Mechanobiology in the management of mobile atrophic and oligotrophic tibial nonunions

BackgroundRecent research indicates that atrophic nonunions are biologically active and may heal in the optimal biomechanical environment.MethodsThirty-three patients with mobile atrophic and oligotrophic tibial nonunions were treated with circular external fixation and functional rehabilitation. Seven patients required autogenous bone graft procedures.ResultsBony union was achieved after the initial surgery in 31/33 (93.9%) tibias. Two persistent nonunions were successfully treated with repeat circular external fixation without bone graft. This resulted in final bony union in 33/33 (100%) patients.ConclusionMechanobiological stimulation of tibial nonunions can produce union even if the biological activity appears to be low.