Aldous, Colleen Michelle.Ferreira, Nando.2017-06-212017-06-2120152015http://hdl.handle.net/10413/14622Doctor of Philosophy in Orthopaedic Surgery.. University of KwaZulu-Natal, Medical School 2015.The management of tibial non-unions remains a challenge for orthopaedic surgeons. The treatment of tibial non-unions is historically based on small case series that frequently include a variety of non-union subtypes and infected cases. Fixation methods and treatment strategies also vary greatly between published series. This lack of uniformity in the available literature has rendered the establishment of evidence-based, reproducible protocols for the management of tibial non-unions difficult. Controversies regarding non-union definition and classification contribute to delays in treatment and exacerbate the morbidity that is commonly associated with non-union development. In this work we propose a new definition for non-union and introduced a novel concept of ‘potential non-union’ to emphasise the importance of early recognition and referral. The lack of reproducible, evidence-based treatment protocols, combined with the large volume of tibial non-union cases managed in KwaZulu-Natal, South Africa, lead to the development of a tibial non-union treatment algorithm. This algorithm was based on results from two retrospective audits of patients with tibial non-unions who were managed with circular external fixators over a four-year period. The algorithm classifies non-unions into four distinct groups, each with a specific treatment strategy. These reports also introduced the concept of mechano-biology to the management of tibial non-unions and were the first to use hexapod circular fixators for distraction of stiff hypertrophic tibial non-unions. Subsequently a prospective interventional study was undertaken aimed at evaluating the effectiveness of the proposed tibial non-union treatment algorithm.en-ZATibia.Fracture fixation -- Complications.Fractures -- Treatment.Bone plates (Orthopedics)Theses -- Orthopaedic surgery.Tibial non-union treatment.Thesis