Surgical Management of Distal Tibia Fracture: Towards An Outcome-based Treatment Algorithm

@#Introduction: Distal tibia fractures are frequently associated with an extensive soft tissue injury which then leads to a higher risk of complications such as infection, non-union and eventually poor overall outcome. The purpose of this study is to measure the outcome of distal tibia fractures treated with internal fixation, external fixator or Ilizarov external fixator(IEF). We aim to propose an algorithm for management of distal tibia fractures by evaluating the treatment options, outcomes and risk factors present. Material and Methods: This study is a cross-sectional study of all distal tibia fractures treated surgically in Tengku Ampuan Rahimah Hospital, Klang from 1st January 2016 till 30th June 2018. Patient records were reviewed to analyse the outcomes of surgical treatment and risk factors associated with it. Results: Ninety-one patients were included with a mean age of 41.5 years (SD = 16.4). Thirty-nine cases (42.9%) were open fractures. Thirty-eight patients (41.8%) were treated with internal fixation, 27 patients (29.7%) were treated with IEF and 26 patients (28.6%) were treated with an external fixator. Among open fractures cases, no significant finding can be concluded when comparing each surgical option and its outcome, although one option was seen better than the other in a particular outcome. Initial skeletal traction or temporary spanning external fixator in close fractures reduced the risk of mal-alignment (p value=0.001). Internal fixation is seen superior to IEF and external fixator in close fractures in term of articular surface reduction (p value = 0.043) and risk of mal-alignment (p value = 0.007). Conclusion: There is no single method of fixation that is ideal for all pilon fractures and suitable for all patients. This proposed algorithm can help surgeons in deciding treatment strategies in the challenging management of distal tibia fractures to reduce associated complications.

Transmission efficiency of Ilizarov external fixator orthopedic force based on coordinate transformation theory / 中国组织工程研究

BACKGROUND: The study on the mechanism of force conduction of Ilizarov bone external fixator is of great significance for clinical orthodontics of the knee varus, the knee valgus and the tibial fracture. OBJECTIVE: To explore the force conduction mechanism of Ilizarov bone external fixator and the force changes of each orthopedic force in the process of tibia correction, and to objectively evaluate the overall use effect of the external fixator. METHODS: According to the structure of the external fixator, the coordinate transformation matrix relations were established, and the mathematical transformation relationship between the holding force and the pulling tension was obtained. A special laboratory bench was set. The experiment of tibia correction was conducted. The load on the external fixator and the variation of the orthotic force were measured. The theoretical value of the tension at the broken bone is calculated and compared with the actual value of the tension measured by the six-dimensional force sensor. The curve of efficiency of force transmission during correction was obtained. RESULTS AND CONCLUSION: (1) During the correction, the structure of the Ilizarov bone external fixator resulted in the interaction and restriction of its adjustment rod and support rod. When one adjustment force increased, the other adjustment force would decrease. (2) The efficiency of force transmission was increased greatly in the early stage, and then stabilized at about 50%. The experimental results could evaluate the overall correction effect of the external fixator. (3) Theoretical calculation and experiment of the tension at the broken bone due to the loss during the force transmission process were different in the result curves, but from the experimental results, it could be indicated that the overall force change trend of the adjustment force, supporting force, the theoretical value of the tension and the actual value of the tension was basically the same, indicating the validity of the theoretical calculations and experimental results. The evaluation results can provide a reference for the optimal design of Ilizarov’s external fixation architecture and the precise control of tibial orthopedic surgery.

Evaluation of the Treatment of GustiloIiia Open Tibial Shaft Fracture TransosseousOsteosynthesis Technique with Ilizarov External Fixator

Background: Fractures of the tibial shaft are important for tworeasons. The first is that they are common, the second is thatthey are controversial - and anything that is both common andcontroversial must be important. Fractures of the shaft of thetibia cannot be treated by following simple sets of rules.Because of its location tibia is exposed to frequent injury and itis the most commonly fractured long bone.Objective: To evaluate the treatment of open tibial shaftfracture of Gustilo IIIA grade by Trans osseous osteosynthesistechnique with Illizarov External Fixator as a primary anddefinite mode of treatment.Methods: Clinical trial (Quasi Experimental study) fromJanuary 2009 to June 2010 (18 months) at National Institute ofTraumatology and Orthopaedic Rehabilitation Purposivesampling was done according to availability of the patients andstrictly considering the inclusion and exclusion criteria andsample size was 17 no of cases.Results: 14 male and 1 female patient between 17 and 51years were studied. Most common age group in this serieswere 26-35 year age group ((53.33%) and average age of thepatients was 30 years with SD of ±8.67. Most of the patientswere male and road traffic accident was the leading cause ofinjury (70.58%). Left side involved in (58.82%) most of thecases and 2 patients had bilateral fractures. Commonest site ofthe fractures were middle third (58.82%) of the tibia. Most ofthe fractures were comminuted type of fractures (47.05%).Most of the patients were operated on the day of admissionand in some cases within 4 - 7 days of admission. Averageduration of hospital stay was 8.06 days ranging from 1 day to28 days. Total duration of treatment was average 186.66 days(26 weeks) highest 291 days (42 weeks) and lowest 140 days(20 weeks). Most of the patient had soft tissue healing bygranulation tissue formation (35.29%). Others were treated byprimary closure, Delayed primary closure, secondary closure,partial thickness skin grafting.Conclusion: In this study the results of open tibia fracture(Gustilo IIIA) by Transosseous osteosynthesis technique withIlizarov External Fixator has been found to be satisfactory.Though there were a few minor complications with the fixatorthe dynamisation and compressing ability of this stable frameprovided good union without any second surgical procedure orbone grafting and prevented any malunion.

​Clinicoradiological Assessment of Treatment of Infective Non-union in Fracture Shaft Femur using Ilizarov Ring Fixator

Background: The management of infective non-union of long bones has always been a dare for orthopedic surgeons. Treatmentgoals were the annihilation of infection and augmenting bony union. For the span of distraction osteogenesis, physiologicalskeletal loading and active mobilization are vital.Aim: This study intended at evaluating the clinicoradiological result of using Ilizarov ring fixator in managing patients withinfective non-union fracture of shaft of the femur.Materials and Methods: A total of 40 patients with infective non-union of the femoral shaft were incorporated in the study between2017 and 2018. The follow-up period lasted for 14–20 months. Skeletal measurements and functional results were calculated,and difficulties were stratified according to the association for the study and relevance of the technique of Ilizarov guidelines.Results: The infection was eradicated in 32 patients before the fixator removal. Tremendous radiological bone healing wasfound in 32 patients and excellent functional result in 28 of 40 patients.Conclusion: Ilizarov ring fixator is a valuable method for the managing of infective non-union of femoral shaft fractures withsatisfactory radiological and clinical outcome and less serious complications.

Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

PURPOSE: Multiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems. MATERIALS AND METHODS: We retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator. RESULTS: Good clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up. CONCLUSION: Treatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.

A Biomechanical Comparison between Taylor’s Spatial Frame and Ilizarov External Fixator

Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.

Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect

PURPOSE: To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect. MATERIALS AND METHODS: 36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method. RESULTS: Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015). CONCLUSION: The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

Modified traction suture holder using an Ilizarov external fixator ring in performing a transanal endorectal pullthrough procedure

This study demonstrates the use of an innovative traction suture holder in performing transanal endorectal pullthrough procedure for Hirschsprung's disease. The device was constructed by utilizing the Ilizarov external fixator ring used by orthopedic surgeons. Used in six patients, the appliance was able to provide adequate exposure of the anal mucosa during the performance of the procedure. Operative time was shorter as compared to that of previous surgeries done without using the appliance.

The Treatment of Infected Nonunions of Femur using Sequestrectomy and Distraction Osteogenesis / 대한정형외과학회잡지

PURPOSE: From this study we are to know the result of distraction osteogenesis for infected nonunions of femur using sequestrectomy and Ilizarov external fixator. MATERIALS AND METHODS: 17 patients who had distraction osteogenesis using external fixator and also had more than 2.5 cm bone loss after sequestrectomy for having infected nonunions of femur from 1991 to 2005. Their average age was 32.4 (range, 10-60) years and mean follow up period was 22 (range, 14-36) months. We used Healing index as an index for bone formation. The results were divided into bone results and functional results and analyzed by grading. Also we estimated the complication according to the Paley's classification. RESULTS: After seqestrectomy, bone defect was ranged from 5cm to 13 cm (average, 7.3 cm) and The average of transportation was 5.8 cm (range, 3-10 cm). HI was 47.4 (27.17-65.80) days/cm. Solid bony union occurred in the all cases after surgery but, 4 cases needed bone graft at docking site. According to the final examination there were 2 cases with leg-length discrepancy that is bigger than 2.5 cm and the average size of was 1.0 cm. CONCLUSION: We consider distraction osteogenesis using Ilizarov external fixator as useful method to restore bone loss caused after sequestrectomy for infected nonunions of femur.

Percutaneous Fixation with Cannulated Screws and Ilizarov External Fixator in Triplane Fracture of the Distal Tibial Epiphysis in Children / 대한족부족관절학회지

PURPOSE: To evaluate the result of percutaneous fixation with cannulated screws and Ilizarov external fixator in triplane fracture of the distal tibial epiphysis in children. MATERIALS AND METHODS: Between May 2004 and December 2007, 14 cases with triplane fractures were treated by percutaneous fixation with cannulated screws and Ilizarov external fixator after underwent CT imaging to assess the fracture pattern, articular disruption and to plan further management. Mean age and follow-up period were 14.1 years old and 15 months respectively. RESULTS: There were satisfactory results in all 14 cases that had excellent reduction and stable fixation. All cases regained full range of movement within 6 weeks. CONCLUSION: We obtained satisfactory result after percutaneous fixation with cannulated screws and Ilizarov external fixator in triplane fractures of the distal tibial epiphysis in children.

Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator

PURPOSE: We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern. MATERIALS AND METHODS: We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern. RESULTS: Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%). CONCLUSION: The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.

Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator

PURPOSE: We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern. MATERIALS AND METHODS: We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern. RESULTS: Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%). CONCLUSION: The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.

Treatment of Fracture and Dislocation of Lisfranc joint with Limited Open Reduction, Pin Fixation and Ilizarov External Fixation / 대한족부족관절학회지

PURPOSE: To evaluate the clinical feature and the results of the treatment of Lisfranc joint fracture/dislocation with limited open reduction, pin fixation and Ilizarov external fixation. MATERIALS AND METHODS: From June 2001 to May 2003, six patients with Lisfranc fracture/dislocation were treated. The average periods of follow-up was 23 months. After limited open reduction on the second tarso-metatarsal joint, we performed pin fixation of the above joint. On the other Lisfranc joint fracture/dislocation, closed reduction and the application of Ilizarov external fixator was done. This rigid system produced the early partial weight bearing and joint motion of the injured foot and ankle joint. The parameters used were radiographic evaluation, patient's clinical assesment and the AOFAS midfoot score. RESULTS: We used the Myerson's criterier to evaluate the radiographic result. All cases could be achieved more than nearly anatomical reduction. Three cases of excellent and 3 cases of good result could be obtained in the evaluation of the patient's clinical assesment. The average AOFAS midfoot score was 87.2 (76~95) points. CONCLUSION: The treatment using Ilizarov external fixation on Lisfranc joint fracture/dislocation can be another useful method.

Comparison of Treating Tibial Nonunion with Bone and Soft Tissue Defect: Ilizarov Only Versus Free Flap and Ilizarov / 대한정형외과학회잡지

PURPOSE: To statistically analyze the advantages of distraction osteogenesis in combination with free flap in the treatment of tibial open fracture with bone and soft tissue defect. MATERIALS AND METHODS: Twenty patients with tibial open fracture with bone and soft tissue defect were treated by distraction osteogenesis with or without flap. Patients were followed up for a minimum of 12 months and retrospectively analyzed, for the admission period, the out patient follow-up period, and the intravenous antibiotic period, and distraction consolidation indices were determined. RESULTS: Those treated with free flap showed statistically significance shorter antibiotic period, admission period, and distraction consolidation indices. CONCLUSION: Free flap and distraction osteogenesis with an Ilizarov external fixator has many advantages for treating tibial open fracture with bone and soft tissue defect.

Treatment of the Difficult Fractures of the Femur Using the Ilizarov External Fixator / 대한정형외과학회잡지

There are many difficult problems and various methods in the treatment of difficult fractures of the femur. We reviewed the records of twelve patients who had been managed with circular external fixation using the llizarov apparatus for difficult fractures of the femur at Keimyung University. Dongsan rnedical center from October 1993 to April l996. There were ten males and two females with an average age of 42 years (range, 16-74 years). Si.x of twelve patients were severely comminuted supracondylar and intercondylar fractures of the femur associated with severe soft tissue injury (including four open fractures). These patients were treated initially by closed reduction with Ilizarov external fixator and followed by compression-distraction techniques. Four of the remaining six ptients developed infected non-unions after internal fixation of the femur without shortening or bone defect. These infected non-unions were treated by curettage, irrigation and Ilizarov application. After the control of infection, compression - distraction techniques were applied. One of the remaining two patients had severe open comminuted fracture of the supra-intercondyle region of femur associated with diaphyseal segmental bone defect (5cm in length). This patient was treated with closed reduction and internal bone transportation usipg llizarov external fixator. One patient with varus deformity (20 degree) was treated by correction of the deformity and simple compression technique. In three patients, additional autogenous cancellous iliac bone graft was done. The union of the fracture site was obtained in ten patients and the duration of llizarov external fixation was an average of 10 months (range 6-14 months). We experienced several complications; there were twelve patients of limitation of motion of knee, ten patients of pin tract infection, one patient of fracture site non-union, one patient of re-fracture and one patient of femoral artery injury. We concluded that the Ilizarov external fixation technique is one of the effective methods for the treatment of difficult fractures of the femur in spite of its complexity and high incidence of complications.

Treatment of Tibial Fractures using the Ilizarov External Fixator / 대한정형외과학회잡지

The purpose of this study is to evaluate the effectiveness of Ilizarov external fixator in the treatment of difficult tibial fractures. We analyzed 37 cases with closed or open comminuted tibial fractures and unstable segmental fractures, treated with Ilizarov external fixator between August 1993 and August 1997. Among them, 21 cases were treated with simple application of Ilizarov external fixator. A compression of the fracture site (6 cases), translation (2 cases) and internal transportation technique (2 cases) were applied, and bone graft was applied in 5 cases. We obtained bony union in all cases with Ilizarov method except one case converted to intramedullary nailing due to delayed union. The average time required for bone union were 21 weeks in closed fractures, 26.2 weeks in open fractures. The complications developed were as follows; pin irritation in 14 cases, pin tract infection in 9 cases, adjacent joint contracture in 3 cases, delayed union in 1 case and malunion in 1 case. According to Tuckers classification, the results were graded as excellent in 18 cases, good in 14 cases, fair in 3 cases, poor in 2 cases. In conclusion, Ilizarov external fixation is one of the useful treatment option in closed or open comminuted tibial fractures and unstable segmental fractures.

Treatment of the Open Tibial Shaft Fractures: a comparison of the Ilizarov external fixator and unreamed interlocking intramedullary nail / 대한정형외과학회잡지

Open fractures of the tibial shaft have a high incidence of complication and often result in poor outcomes. The most common method of stabilization is the external fixation by way of the Ilizarov method but the small diameter interlocking intramedullary nailing has also been introduced. The purpose of this study is to analyze the result of Ilizarov method and to compare its results with those of delayed intramedullary nailing used in the treatment of open tibial shaft fractures. We analyzed 81 patients with open tibial shaft fractures, treated using Ilizarov external fixator, or by delayed locked intramedullary nailing between January 1987 and December 1994. The follow-up period was an average 14.5 months. Out of the 81 patients, 58 patients were treated by nails and 23 patients by Ilizarov external fixators. Both groups were given the same initial management but the operation of the nailing group was delayed until proper soft tissue coverage and healing of the wound were evident. In the Ilizarov method group, 58 fractures obtained union within 26 to 53 weeks (average of 32.8 weeks) and in the nailing group, 23 fractures showed union within 14 to 51 weeks (average of 21.2 weeks). There was a significant difference between the two groups (P<0.05). Complications in the Ilizarov group included 4 nonunions, 12 delayed unions, 3 malalignments, 14 wound infections and 13 stiff ankles. There were no nonunion, 10 delayed unions, 8 malalignments, 6 wound infections and 11 stiff ankles in the nailing group. In this study, the Ilizarov group had more delayed unions and nonunions took a longer period of time to obtain the union, and had a more limited range of motion in the ankle, than the nailing group. The nailing group was easier to manage, especially in the soft tis-sue procedure, and it did not require a high level of compliance while having a relatively low risk of malunion.

Treatment of the Difficult Fractures of the Femur using the Ilizarov External Fixator / 대한정형외과학회잡지

There are many difficult problems and various methods in the treatment of difficult fractures of the femur. Form May 1991 to August 1994, 9 cases of difficult fractures of the femur were treated with Ilizarov external fixator. We obtained good result for all cases as follow : 1. There were 1 case of severely segmental and comminuted fracture with bone loss, 3 cases of infected nonunion after internal fixation(2 cases combined with bone loss), 2 cases of non-union after internal fixation and 3 cases of severely segmental and comminuted fractures. The traffic accident injury was in 6 cases and the falling down injury was in 3 cases. 2. The bone union was obtained in all cases and the duration of Ilizarov external fixator application was minimum 7.7 months up to 19 months with an average of 1.3 months and full weight bearing was possible in all cases after removal of the Ilizarov external fixator. 3. We experienced 9 complication; there were 6 cases of pin tract infection which were controlled by antibiotic injection at that site and there were three cases of limitation of motion of knee. So we conclude that the Ilizarov external fixation technique is one of the effective methods for the treatment of difficult fracture of the femur(ex. segmental, comminuted fracture, bone defect, osteomyelitis and nonunion) in spite of having experienced only few cases.

Management of unstable open and closed Tibial Fractures using the Ilizarov Method / 대한정형외과학회잡지

We reviewed thrity-one cases of unstable tibial fractures treated with Ilizarov method from January 1991 to December 1992. We attained satisfactory bony union in all cases without bone graft(Average time 19.2 weeks). There were numbers of complications, but its were soluble and careful management & numbers of minor surgery were needed to prevent & solve such complications. Post-op immediate weight bearing and ROM exercise were possible and showed no difficulty in getting mainteance of reduction & fracture healing, and serious joint ankylosis was not developed. In conclusions, Ilizarov method is an excellent treatment in getting reduction, maintenance of reduction, early ambulation and fracture healing in the cases of unstable tibia fractures.

The Treatment of Infected Nonunion by the Ilizarov Technique / 대한정형외과학회잡지

The goal of treatment in infected nonunion include the elimination of infection, deformity and defects as same time as obtaining union. It is very difficult to obtain union and to correct deformity, infection and shortening in infected nonunion. The purpose of this study is to review the results of treatment of infected nonunion by the Ilizarov technique. Nineteen patients with infected nonunion were treated using Ilizarov external fixator from july 1991 to September 1993. Seven patients are undergoing treatment until now, so those were excluded from this data. Twelve patients were achieved bony union. Eleven cases were united and one case was failed with Ilizarov external fixator. We analyzed twelve cases. There were eleven males and one female, eight tibias and four femurs. Bony union was achieved by direct compression in six cases. Six cases were treated by bifocal osteosynthesis, but five cases were achieved bony union and one case was failed. So, we achieved bony union with intramedullary nailing and bone graft. The results were summarized as follows; 1. Eleven cases of infected nonunion were united with Ilizarov external fixator. The mean time to union of infected nonunion site was 10. 8 months. 2. The average bone lengthening of six cases was 64mm, ranging from 15mm to 110mm. The healing index averaged l. 64 month/Cm. 3, The bone results were excellent in six cases, good in five cases, poor in one case. The functional results were excellent in four cases, good in seven cases, fair in one case. 4. In all cases, we experienced difficulties. So we concluded that Ilizarov technique for infected nonunion is a valid procedure for control of infection, union, bone defect and deformity.