The role of an Ilizarov external fixator in the treatment of post-traumatic tibial nonunion in children

Abstract

Background Tibial fractures are the third most common long bone fractures in children. Acutely, they can be treated conservatively with cast immobilization and also surgically with external fixation, plate, and screws' fixation or intramedullary implants. Post-traumatic tibial pseudoarthrosis as a complication is relatively uncommon in children. This article reports our experience with the use of the Ilizarov external fixator in the treatment of post-traumatic tibial nonunion in children. Patients and methods Between 2003 and 2010, 14 child with post-traumatic tibial nonunion were treated in our department. The ages of the patients ranged from 4 to 13 years (mean 8 years, 6 months). All patients had open physes at the time of injury. Twelve patients were boys and two were girls. Twelve fractures involved the diaphysis, where two were confined to the distal metaphysis. There were 10 open fractures. There were five type IIIA, four type IIIB, and one type IIIC fractures, according to the classification of Gustilo. Of the 14 patients, three had infected nonunion. In this study, stabilization with a bifocaI Ilizarov external fixator (acute shortening and compression at the nonunion site, and distraction osteogenesis of the tibia through metaphyseal corticotomy) was performed in all cases. Results The average duration of follow-up was 20 months (range 12-36). Union was achieved in all cases. Time to union ranged between three debridement of the nonunion site and only one bone to 9 months, with an average of 5.5 months. Six patients had a gap range of 2-4 cm after transport was grafted using an autogenous graft from the iliac crest. All the patients had almost equal leg lengths (leg-length discrepancy Conclusion Treatment of post-traumatic tibial nonunion in children by an Ilizarov external fixator is effective in restoring length, correcting alignment, and achieving solid bony union through a one-stage operation.