Non-union of the Distal Tibia Due To Uncorrect Osteosynthesis. Management and Discussion

Distal tibia fractures are 7-10% of alltibial fractures and they are caused both by high and low energy traumas with different fracture pattern. We present a case report of a 23 year old female affected by mental delay, who fall down in March 2014 reporting the fracture of the distal tibia. She has been operated in emergency with two elastic nails and a lag screw. Two months after she has been subjected to a second surgery for hardware removal and new fixation with medial LCP plate after fibular osteotomy. During the follow-up the fracture displaced in valgusmal alignment and the patient arrived to the attention of the first author in June 2015. A new surgery was necessary to re-establish the correctaxis of the leg; after hardware removal a new fibular osteotomy has been perfomed, the fracture has been fixed with lag screw and LCP plate and bone graft, Judet decortication and medullary canal opening were necessary to give biological stimolous for non-union healing. The possible causes of the non-union are analyzed, discussed and compared to literature. The correct indication for fracture fixation is mandatory to avoid complication which can led to not acceptable malalignment and subsequently to revision surgery for the patient with more risks for the finalresult.