Outcome of Bone Transport Using Ilizarov External Fixator in Infected Non-union of Tibia with Large Bone Defects: Comparison of Those with 5-10cm Bone Defect with Those Having ≥ 11cm Bone Defect.

Abstract

Ilizarov external fixation has become the treatment of choice for infected non-union of tibia. Varying degrees of bone loss and different strategies of treatment in the published reports make comparingoutcomes difficult. This study hopes tobridge thisgapin the literature by focussing exclusively on bone transport in patients with bone loss of 5cm or more. Thisis a prospective case series conducted at a tertiary level orthopaedic speciality hospital. Outcomes are measured by Association of the Study and Application of Method of Ilizarov (ASAMI) bony scores, ASAMI functional scores, Lengthening Index and by assessing complications encountered. There were 49 patientsin this study withan average of 9.57cm bone gap. Among these,29 patients had a bonegap of 5-10cm and 20 patientshad a bone gap of ≥ 11cm.According to the ASAMI bony score, 42 patients had excellent or good outcomes with two fair results and five poor results. The ASAMI functional scores were 45 excellent to good outcomes, four fair and no poor results or failures. Fixed flexion deformity of the knee of more than 5°, ankle stiffness and soft tissue interposition were significantly more frequent in those with bone gap of ≥ 11cm. Trifocal transport and bone grafting at docking significantly improved the lengthening index. Even massive bone defects of 11cm or more can be reliably healed by bone transport using Ilizarov external fixation, but with a significantly higher rate of complications. Level IV.