Treatment of nonunited tibial fractures by Ilizarov Technique

ABSTRACT

Twenty-two patients aged seven to fifty four years were treated between January 1993 and September 1995, for tibial nonunion [seventeen atrophic and five hypertrophic] by the Ilizarov technique and fixator. Fifteen had chronic osteomyelitis, [septic nonunion], eighteen had a leg-length discrepancy, sixteen had a bony defect [1-10 cm, mean 6 cm]. Five cases had shortening without defect, three with bone defect without shortening and thirteen had both a bone defect and shortening. Nonunion, bone defect, limb shortening, infection and deformity all can be managed simultaneously with the Ilizarov apparatus. Bone defects were filled from within, without bone graft, by the Ilizarov bone transport technique of sliding a bone fragment internally, producing distraction osteogenesis behind it until the defect was bridged [internal lengthening]. Length was reestablished by distraction of a percutaneous corticotomy or osteotomy together with intermittent compression and distraction at the nonunion site [External lengthening]. Distraction osteogenesis resulting from both processes eliminated the need for a bone graft. Deformity was corrected by means of hinges on the apparatus. Infection was treated by radical resection of necrotic bone and internal lengthening to regenerate the excised bone. Union was achieved in twenty cases. The mean time to union was nine months [range 6-30 months]. The bone results were excellent in twelve cases, good in five, fair in three and poor in two cases. The functional results were excellent in eleven cases good in six cases, fair in two and poor in three cases. The commonest complications encountered were pin tract-infection andfixator instability. No serious vascular complications were encountered. Four cases developed paraethesia in the distribution of the common peroneal nerve