ABSTRACT
Objective To explore the curative effects of external fixation in the treatment of infected nonunion.Methods From June 2009 to December 2016,45 patients with infected nonunion were treated by external fixation at Department of Orthopaedics,West China Hospital.They were 36 males and 9 females with an average age of 45.3 years (range,from 14 to 65 years).The sites of fracture included tibia in 31 patients,femur in 12,humerus in one,and ulna-radius in one.The median time from injury to application of external fixation was 16.8 months and the average number of previous operations was 2.3 times.After debridement,24 cases had a bone defect of 6.0 cm in length on average (range,from 3.5 to 10.4 cm).After discharge,the patients were regularly followed up at the outpatient department and any of their complications was recorded in detail.At the final follow-ups,the protocol of ASAMI (Association for the Study and Application of the Method of Ilizarov) was used to evaluate their bone and functional results.Results All the 45 patients were followed up for 16 to 106 months (average,43.9 months).One patient had to receive amputation because of uncontrollable infection and all the other 44 cases achieved bony union.The bone defects were successfully reconstructed by external bone transport in 24 patients.The time for external fixation averaged 20.5 months.According to the evaluation by ASAMI at the final follow-ups,the bone was rated as excellent in 28 patients,as good in 12,as fair in one and as poor in 3,giving an excellent to good rate of 90.9％;the function was rated as excellent in 11 patients,as good in 21,as fair in 8 and as poor in 4,giving an excellent to good rate of 72.7％.Conclusion In eradication of infection and treatment of fracture nonunion,external fixation can be used not only to avoid the infection risk due to internal fixation but also to correct a complex deformity and repair a large bone defect,allowing early weight-bearing for the patients.