Accordion technique in the treatment of tibial delayed union or nonunion

Objective To assess the clinical curative effect of accordion technique in the treatment of tibial delayed union or nonunion. Methods From February 2016 to December 2017, data of 11 patients with tibial delayed union (n=8) or non-union (n=3) who had been treated by accordion technique with an Ilizarov ring external fixator were retrospectively analyzed. 10 males and 1 female were included in our study, with an average age of 41.9 years (range, 21-63 years). There were 5 cases of docking site delayed union after Ilizarov transport for chronic tibial osteomyelitis. There were 3 cases of fracture site delayed union after external fixation for open tibia comminuted fracture. There were 3 cases of nonunion after tibia closed fracture, including 2 cases who had hybrid external fixation treatment, and 1 case who had conservative treatment. All the cases received accordion technique using Ilizarov ring external fixators. First, gradual compression at the fracture site was conducted until the bony contact was seen on a radiograph. After bony contact, compression was continued at a rate of 0.85 mm/d for a week, followed by distraction of 0.85 mm/d for 2-3 weeks. Afterward, a second compression was conducted using same rate and time with the distraction procedure. And there was a 7-day latent period between compression and distraction. One or two cycles of compression-distraction were needed before union was present radiographically. Results Bony union was obtained in all 11 patients after a mean time of 5.4 months (from 3 to 9 months). The mean follow-up for the 11 patients was 15.2 months (from 11 to 29 months). The mean duration of the accordion technique treatment was 50.2 d (range, 35-67 d). The accordion technique was used 1 time for 8 patients, and 2 times for 3 patients. The mean duration of bone consolidation was 114.9 d (range, 64-239 d). According to Paley evaluation criteria, osseous results were excellent in 8 cases, good in 3 cases, with a good to excellent rate of 100%(11/11); functional results were excellent in 7 cases, and good in 4 cases, with a good to excellent rate of 100%(11/11). Conclusion The accordion technique is a minimal invasive, safe and reliable treatment program for tibial delayed union or nonunion. Key words: Tibial fractures; Fractures, ununited; External fixators