Management of post-traumatic extra-articular proximal tibial nonunion by Ilizarov external fixation

Abstract

Background The Ilizarov technique has been used in Egypt for the past 20 years in the management of nonunion of long bones. This method uses fine wires and pins inserted percutaneously, which are attached to provide a strong frame construct. Most tibial and femoral nonunions can be treated successfully by internal fixation. However, proximal tibial nonunion can prove a difficult problem. The Ilizarov method can prove useful for treating these complex injuries. Objective The aim was to evaluate and analyze the clinical and radiological outcomes of Ilizarov external fixation in treatment of proximal tibial nonunion prospectively while focusing on its effectiveness, advantages and complication. Patients and methods A total of 16 patients (11 male and five female; average age: 33.5 years) who had post-traumatic extra-articular proximal tibial nonunion between April 2010 and October 2011 treated with the Ilizarov technique were included. Intervention method was Ilizarov technique, and main outcome measures include functional and radiological outcomes assessed using the Association for the Study and Application of Methods of Ilizarov criteria. Results All 16 patients showed union. None required amputation. According to the Association for the Study and Application of Methods of Ilizarov score regarding bone/radiological results, eleven were classed as excellent, four were good and one patient was fair. Functionally 10 patients were graded as excellent, five as good and one as fair. Conclusion The Ilizarov method is a reliable tool allowing early definitive treatment with a low complication rate and a good clinical outcome in treatment of patients with proximal tibial nonunion.