Monofocal and bifocal management of infected femoral nonunion by an Ilizarov fixator: midterm results

Abstract

Introduction Infected nonunion of the femur with associated bone loss represents one of the most difficult problems in orthopedic practice. The purpose of this study was to evaluate the midterm treatment outcome of the Ilizarov technique in infected nonunion of the femur. Patients and methods This is a retrospective study of 24 patients with infected nonunion of the femur treated by an Ilizarov external fixator. The mean age of the patients was 37.71 years. The study included 19 men and five women. Eighteen (75%) patients had draining sinuses while six (25%) were quiescent. Four cases had associated deformity, and 18 patients had preoperative shortening with a range of 1–6 cm. Failed previous surgeries ranged from two to seven times and the mean duration of nonunion was 28.75 months. Results Monofocal technique was used in eight patients, and bifocal technique was used in 16 patients. All fracture nonunions were fully united with a mean fixator period of 12.75 months. The average follow-up duration was 50.88 months. Persistent infection occurred in two cases after frame removal and managed by further debridement. Two cases had residual valgus deformity and two other patients had 2.5 cm shortening. According to the Association for the Study and Application of the Method of Ilizarov criteria, the bone results were evaluated as excellent in 19 patients, good in four patients, and fair in one patient. The functional results were excellent in 18 patients and good in six patients. Conclusion In spite of the several problems, obstacles, and complications that may occur with the long treatment course, the Ilizarov fixator was effective in treating the difficult disabling problem of infected nonunion of the femur.