The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method

The purpose of this study was to demonstrate the effectiveness of the Ilizarov method and circular external fixator in order to eradicate the infection and restore bone union, limb anatomy and functionality in cases with infected nonunion of the tibia following intramedullary nailing During 7 years nine patients suffering from infected nonunion of the tibia after intramedullary nailing were treated in our department. The series comprised seven men and two women with an average age of 397 years (range 21-75 years) The patients had previously undergone an average 0148 operations (range 3-6 operations). Active purulent bone infection occurred in all nine patients Bone defect was present in all patients with a mean size of 5 cm (range 2-12 cm) In three cases with bone defect less than 2 cm, monofocal compression osteosynthesis technique was used. In the rest cases where bone defect exceeded 2 cm. bifocal consecutive distraction-compression osteosynthesis technique was applied Three patients required a local gastrocnemius flap The mean follow-up period was 266 months (range 13-42 months) Results were evaluated using Paley's functional and radiological scoring system Bone union was achieved in all nine patients without recurrence of infection during the follow-up period Bone results were graded as excellent in five cases and good in the rest four cases Functional results were graded as excellent in three cases, good in lout and fare in two cases Mean external fixation time was 187 4 clays (range 89-412 days) and mean lengthening index was 32 days/cm (range 27-39 days/cm) Complications observed included eight grade II pin tract infections, axial deformity at the lengthening site in two cases and at the nonunion site in another two cases Ankle Joint stiffness was detected in five cases. The Ilizarov method may be an effective method in infected nonunions of the tibia following intramedullary nailing. (C). 2009 Elsevier Ltd All rights reserved