Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection.

Abstract

Non-union of the tibia associated with infection was treated with radical resection of the necrotic bone and distraction osteogenesis in twenty-eight patients who were eighteen to seventy-four years old. Non-union, infection, shortening, deformity, and osteoporosis were all addressed simultaneously. All patients had either one-segment or two-segment lengthening of bone with a technique of bone transport in which a bone fragment is moved toward the site of non-union, leaving a defect that is bridged by distraction osteogenesis. The size of the bone defect that was bridged averaged six centimeters (range, two to thirteen centimeters). The infection was eradicated in all patients before the fixator was removed. The mean duration of treatment was ten months. The mean time to union, calculated from the day that the intercalary segment came into contact with the target segment, was six months. The mean duration of follow-up was thirty-nine months. The deformity and the inequality of the lengths of the legs were corrected successfully--to less than 7 degrees and to less than 2.5 centimeters, respectively--in fourteen of the twenty-eight patients. In these fourteen patients, the bone result--determined according to the criteria of union, healing of the infection, status of the deformity, and amount of residual shortening--was considered excellent. Of the fourteen remaining patients, eight had a good bone result; one, a fair result; and five, a poor result. The functional result was excellent in seven patients, good in eleven, fair in four, and poor in five. One patient had an amputation. Three patients (11 per cent) had a problem with union that was treated with augmentation with a bone graft. One patient, who had sustained a refracture, had an amputation. Twenty-five patients (89 per cent) had a total of seventy-one minor or major complications, a rate of 2.5 complications per patient.