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  • Title: Delayed union and nonunion of the tibia: experience in a community teaching hospital.
    Author: Harrington IJ, Barrington TW, Evans DC, Malcolm BW, Simmons EH.
    Journal: Can J Surg; 1987 May; 30(3):204-6. PubMed ID: 3580982.
    Abstract:
    Delayed union and nonunion are frequent sequelae of high-energy tibial fractures, particularly compound ones. The authors studied 45 such cases; of these, 20 fractures were compound. The authors analysed the initial management but found no apparent correlation between the initial management of these fractures and subsequent delayed union or nonunion. The Phemister bone-grafting technique was used to achieve union and was considered a safe, efficacious method. Aggressive initial management of the soft-tissue component of tibial fractures is recommended to minimize the possible development of chronic osteomyelitis, a serious complication that occurred in eight patients and necessitated below-knee amputation in three.
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