Infected Nonunion Of Long Bones Research Articles

Marginal bone resection and immediate internal fixation in multidrug resistant chronic septic nonunions of lower limb long bones: a case series.

This study aimed to evaluate the efficacy of a combined treatment approach integrating extensive debridement, immediate internal fixation, and the Masquelet technique for the management of infected nonunion of long bones in the lower limbs caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria. This retrospective case series was conducted at the Imam Khomeini Hospital Complex, Tehran, Iran, a tertiary-level academic referral centre. The study documented consecutive cases of patients presenting with infected nonunion of the tibia or femur, with a positive culture for MDR or XDR bacteria, treated between January 2019 and December 2022. Inclusion criteria were adults with a confirmed diagnosis of infected nonunion due to MDR or XDR bacteria, with exclusion criteria including patients with unrelated infections or allergies to the components of the treatment regimen. The primary outcomes measured were infection resolution and bone healing. The study cohort comprised 16 patients, predominantly male (87.5%) with an average age of 38.5 years. Methicillin-resistant Staphylococcus aureus (MRSA) was identified as the causative agent in 31.25% of the infections. Patients were followed for a period ranging from 12 to 26 months. The treatment protocol was uniformly applied across all cases. Successful bone union was observed in the majority of patients within 140 to 240 days following grafting. However, there were two instances where amputation was necessitated due to the failure to eradicate the infection. Complications arose in three cases during the follow-up period: two required re-debridement due to a recurrence of the infection, and one was subjected to bone transport owing to persistent nonunion. Notably, all cases that either failed or encountered complications were smokers. In this integrated approach, high rates of infection resolution and bone healing were achieved, suggesting this method as a viable option for these complex cases.

Functional Evaluation of Long Bone Nonunion Managed by Limb Reconstruction System

Abstract Background: The management of infected nonunion of long bones is a demanding task for the treating surgeon. Various treatment options have been tried in the past with less than satisfactory outcome. The purpose of the study was to establish the efficacy of limb reconstruction system (LRS) in the treatment of nonunion of the tibia and the possibility of correcting any bone length discrepancy. Materials and Methods: A prospective cohort study was performed on 30 patients with infected nonunion of lower limb long bones, treated with LRS for 2 years between November 2018 and December 2020, in our institution. The outcome was evaluated on the basis of bone union and functional outcome using the Association for the Study and Application of the Method of Ilizarov (ASAMI) score. Results: According to the ASAMI score, results were excellent in 75% good in 10%, fair in 5%, and poor in 10% of patients. The average union time was 44 weeks and average fixation time was 46 weeks. Conclusion: LRS is a lightweight, patient-friendly device that does not interrupt patient’s day-today activities. It is useful for managing limb length discrepancies, allows early mobilization and better wound management, thus it is an effective and versatile treatment modality in infected nonunion of the tibia.

A prospective study on the role of limb reconstruction System in infective non-union of femur and tibia

Introduction: Infected non-union of long bones is the state of failure of union and the persistence of infection at the fracture site for a period of 6 to 8 months or more. This condition possesses a challenge for optimal treatment to the orthopaedic surgeon. Limb reconstruction system (LRS) is a single bar device with telescoping facility which allows increased axial movement at the fracture site by permitting conversion from rigid to dynamic fixation resulting in formation of external bridging callus. The regenerated bone restores length and eliminates infection. This procedure does not require much expertise of the treating orthopaedic surgeon and is associated with high patient compliance.Materials and Methods: 20 adult patients with infective non-union of femur and tibia were admitted in Silchar Medical College and Hospital, Silchar between September 2019 to August 2020 after being diagnosed clinically and radiologically as infective non-union. Preoperative radiographs were taken to assess the type of non-union, presence of infection, implants, quality of bone stock and level of non-union. Patients were classified according to the classification by Rosen et al. in the A.O. manual into quiescent, active and draining types. Follow up was done every 4 weeks and Association for the Study and Application of Methods of Ilizarov (ASAMI) score was used to categorize the outcome into excellent, good, fair and poor.Results: It was observed that 90% patients showed excellent to good functional as well as bone healing outcomes.Discussion: Results of mean bony transport, mean implant index and outcomes are comparable to previous studies conducted.Conclusion: LRS application to infective non-union of long bones is a cost-effective procedure which favours both the surgeon and patient as compared to other available treatment modalities.

Outcome of treating osteomyelitis and infected non-union of long bones with antibiotic coated bone cement nails

Introduction: Nonunion in the presence of infection poses the combined dilemma of infection management and stability. The purpose of this research was to determine the function of antibiotic cement coated nailing in infection management and bony union of infected non-union of long bones.Methodology: This prospective observational study was conducted in the Department of Orthopedics, Janki Medical College, Janakpur, Nepal from August 2016 till August 2021. In this study, we included patients aged 18 years or above, who were treated with antibiotic cement coated nailing for infected non-union post-operative fractures of tibia or femur. 2 g of vancomycin and 2 g of gentamycin were put into every 40 g of bone cement. Clinical, radiographic, and haematological markers were used to assess infection control and osseous union.Results: In the present study, 50 patients were included, with a mean age of 37.3 ± 6.2 years, and 72% of the patients were males (n=36) and rest being females (28%, n=14). Tibia was involved in 60% of the cases and rest had their femur involved. Wound culture revealed staphylococcus aureus in 60% of the patients and Enterobacter in 20% of the patients. At 6 months, bone union was achieved by 92% of the patients, infection control was achieved in 94% and 90% had no complications. Reinfection was observed in four cases (4%), nail break, nail migration and malunion was observed in one patient each.Conclusions: Based on the results, it appears that antibiotic cement coated nailing in the therapy of infected non-union of long bones is a good method for achieving early infection control.

Surgical and functional outcomes of infective non union of femur and tibia using ilizarov ring fixator

Introduction: Nonunion of long bone fractures is a common condition encountered by an orthopedic surgeon in daily practice. For effective treatment of nonunion, internal fixation with or without bone grafting can be done but, an infected non union can prove to be a tough challenge. The aim of our study is to assess the surgical and functional outcomes of infected nonunion of femur and tibia treated with debridement, corticotomy and Ilizarov ring fixator. Materials and Method: This was a multi-centric prospective study of twenty patients in a time span of three years from May 2017 till April 2020. Observations and Results: Patients were assessed using clinical and functional results as per Association for the Study and Application of Methods of Ilizarov (ASAMI) Scoring System. Conclusion: The Ilizarov method remains one of the most successful and versatile means of achieving bone-healing in infected nonunion of long bones of lower limbs with benefits of correcting deformities, bone defects and limb length discrepancy.

Early definitive internal fixation for infected nonunion of the lower limb

BackgroundThe management of an infected nonunion of long bones is difficult and challenging. A staged procedure comprising radical debridement followed by definitive internal fixation was favored. However, no standard treatment has been established to determine the appropriate waiting period between initial debridement and definitive internal fixation. We propose a management method that incorporates early definitive internal fixation in infected nonunion of the lower limb.MethodsThirty-four patients (28 men and 6 women; mean age 46.09 years; range 25–74 years) with infected nonunion of the tibia or femur were included. Initial infected bone resection and radical debridement were performed in each patient in accordance with the preoperative plans. Definitive surgery was performed 2–3 weeks after the resection (4 weeks after flap surgery was required), and a third surgery was performed to fill the bone defect through bone grafting or transport (three-stage surgery). In cases of unplanned additional surgery, the reason for the requirement was analyzed, and radiological and functional results were investigated in accordance with the Association for the Study and Application of the Method of Ilizarov criteria.ResultsBone union was achieved in all patients, and treatment was conducted as planned preoperatively in 28 patients (28/34, 82.35%). The mean interval between primary debridement and secondary definitive fixation was 2.76 weeks (range 2–4 weeks). Six unplanned additional surgeries were performed, and the infection relapsed in two cases. The radiological and functional outcomes were good or better in 32 and 31 patients, respectively.ConclusionsEarly definitive surgery can be performed to treat infected nonunion by thorough planning and implementation of radical resection, active response to infection, restoration of defective bones, and soft tissue healing through a systemic approach.

An Interventional Study on Antibiotic Cement-coated Nails and Cement Beads in the Management of Infected Nonunion of Long Bones

An Interventional Study on Antibiotic Cement-coated Nails and Cement Beads in the Management of Infected Nonunion of Long Bones

Outcome of Infected Nonunion of Long Bones Treated by Single-Stage Bone Grafting and External Fixation at Northwest General Hospital, Peshawar, Pakistan

Background: Infected nonunion of long bones after fractures is one of the most challenging complication to treat in clinical practice. It is commonly treated by a two-stage approach; controlling infection initially and then application of external fixator and bone graft. Treatment with Ilizarov had been the gold standard but is associated with few complications. The objective of the study was to evaluate the clinical, radiological and functional outcomes of infected non-union of long bones treated with single-stage bone grafting and external fixation.Material and Methods: This retrospective study was carried out at Orthopedics Department of Northwest General Hospital, Peshawar Pakistan from 2014 to 2019. Medical records of 17 patients, aged 32 years and treated with Single-stage bone grafting and external fixation were reviewed. Nonunion included 7 humerii, 5 femurs, 3 tibias and 2 radius/ulna. Preoperative plain radiographs for any sequestrum or sclerosed bone margins and baseline investigations (like CBC, ESR, CRP and Vitamin-D status) were reviewed. All patients underwent radical debridement, reaming of intramedullary canals, external fixation and autogenous bone grafting. The outcomes evaluated were union of the bone (clinically and radiologically), resolution of infection, complication rate and number of re-intervention surgeries.Results: Among 17 patients, 10 were males and 7 were females. After treatment, mean follow-up duration was 9.414.48 months (4–18 months). None of the patients were lost to follow-up, had recurrence of infection or required further surgery. The mean duration of bone union was 8.4  4.48 months (range 3 to 17 months) and all of the patients achieved infection free union with satisfactory functional outcome.Conclusions: Single-stage bone grafting and external fixation is an effective technique in terms of resolution of infection and satisfactory bone union without any complications and can be used as an alternative to Ilizarov for treating cases of infected nonunion of long bones.

English

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union

STUDY ON OUTCOME OF TREATMENT OF NONUNION LONG BONE FRACTURE

The aim of the study is to analyze the outcome of treatment of infected Nonunion of long bones using limb reconstruction system and to reveal its real usefulness Nonunion is diagnosed, until clinical or radiographic evidence shows healing has ceased and that union is highly improbable. Nonunion is dened as “established when a minimum of 9 months has elapsed since injury and the fracture shows no visible progressive signs of healing for 3 months This is a prospective and retrospective study which consists of 30 cases in the age range from 20 yrs to 65 yrs Patients who were lost to follow up were not included in this study. Our institution approved our treatment protocols and all patients gave written informed consent. ASAMI' criteria were used to analyze the results in our study. In this study we conducted, we could achieve a success rate of 80%, giving good encouraging results to most of our patients. Hence we conclude that the Indian version of the Limb reconstruction system is effective and convenient method for the treatment of infected nonunion of long bones. This can also be used to correct the limb length discrepancies simultaneously, which can arise during the course of the treatment.

Ilizarov bone transport to treat infected nonunion of long bones: a multicenter retrospective cohort study.

ObjectiveTo examine the efficacy and safety of Ilizarov bone transport in the treatment of infected nonunion of long bones.MethodsPatients who underwent Ilizarov bone transport for treatment of bone nonunion with chronic osteomyelitis in the three largest regional orthopedic trauma centers in China from July 2013 to July 2018 were retrospectively examined. Treatment results were evaluated with Paley’s criteria for bone healing and functional assessment.ResultsIn total, 189 patients were treated during the study period. The study population comprised 135 male and 54 female patients with an average age of 37.5 years (range, 11–61 years). The patients were followed up for at least 24 months. According to Paley’s criteria for bone healing and functional assessment, the bone healing results were excellent in 115 (61%) patients, good in 31 (16%), fair in 21 (11%), and poor in 22 (12%). The functional evaluation results were excellent in 76 (40%) patients, good in 65 (34%), fair in 22 (11%), poor in 26 (14%).ConclusionInfected nonunion of long bones can be effectively and safely treated with Ilizarov bone transport.

Outcome of limb reconstruction system in tibial infected non-union and open tibial diaphysial fracture with bone loss

IntroductionIncidence of open fractures of the long bones is increasing due to the increase in road traffic accidents (RTA) which leads to an increased incidence of complex non-unions of long bones. Patients are usually operated many times for fracture fixation (and healing) or to eradicate infection, which causes soft tissue scarring and devitalization of any surviving bone. ObjectiveIn this study, we assess the outcome of the Limb reconstruction system in tibial infected non-union and open tibial diaphyseal fracture with bone loss. MethodIt is a prospective study conducted on 15 patients and patients included in this study having compound fractures of shaft tibia with bone loss classified by Gustilo-Anderson open fracture classification. With the defect in the distal tibia, proximal corticotomy 1.5 cm distal to the last screw in the proximal clamp and proximal to distal transports were done and vice versa. All patients were evaluated with the ASAMI scoring system into bone results and functional results. ResultsIn the majority of patients, the injury was caused by road traffic accidents 80% of cases. Out of 15 cases, 2 belong to the upper 3rd, 9 cases belong to the middle 3rd and 4 cases belong to the lower 3rd of shaft tibia. The union time ranges from 4 to 11 months but the maximum union was achieved in 7–9 months in 8 (53.33%). Pin tract infection was reported in two (13.33%) patients who became better with regular dressing. Ankle stiffness was present in one case (6.67%), most probably due to improper physiotherapy.According to ASAMI Criteria excellent radiological results were present in 11 (73.33%) cases, good results were found in 4 (26.67) cases and excellent functional results were observed in 7 cases (46.67%) and good results were found in 8 (53.33%) cases. Infection was cured in all patients and did not recur till the last follow-up. ConclusionsAdvantages of rail fixator include less invasive surgery, early weight-bearing, less infection, less blood loss, prevention of diffuse osteoporosis and atrophy, preservation of limb function, no need for bone grafting, correction of deformity during the process of healing, thus no need for a second surgery. Non-union, bone defect, and deformity can be corrected simultaneously. Hence, we recommend the use of this system (rail fixator) especially for infected non-union of long bones and compound fractures with bone loss.

The Fate of Patients After a Staged Nonunion Procedure for Known Infection.

To determine the factors associated with successful union and eradication of infection in the setting of staged procedures to treat obviously infected nonunions of long bones. We hypothesize that patients with positive intraoperative cultures obtained at the time of definitive surgery for infected nonunions are more likely to have persistent nonunion than those with negative cultures. Multicenter retrospective review. Eight academic Level 1 trauma centers. Patients who underwent staged management for obviously infected nonunion of a long bone. For each patient, initial fracture management, management of retained implants, number of debridements, grafting, bacteriology, antibiotic course, bone defect management, soft-tissue coverage, and definitive surgery performed were reviewed. A total of 134 patients were treated with staged procedures for obviously infected nonunion of a long bone (mean age 49 years, 60% open fractures, and mean follow-up 22 months). During definitive procedures, 120 patients had intraoperative cultures taken with 43% having positive cultures. For culture-positive patients, 41 patients achieved eventual union and 10 had persistent nonunion. Of 69 culture-negative patients, 66 achieved eventual union and 3 had persistent nonunion. The number of patients with union versus persistent nonunion was statistically significant between culture-positive and culture-negative groups (P = 0.015). Management of infected nonunion in long bones with staged treatments before definitive fixation are beneficial but ultimately less effective when performed in the setting of positive bacterial cultures at the time of definitive management. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Induced Membrane Technique Using Combined Free Fibular and Iliac Graft for the Treatment of Infected Nonunion of Long Bones of the Lower Limb

The two-stage induced membrane technique became widely accepted in treatment of infected nonunion. The aim of this study was to evaluate the outcomes of the induced membrane technique using combined free fibular and iliac bone graft in treatment of infected nonunion of long bones of the lower limb. This study comprised 45 consecutive patients (27 femoral, 18 tibial) with infected nonunion of long bones of the lower limb. The mean age of the patients was 35 years. There were 40 males and 5 females. The right side was affected in 30 patients. Comorbidities were present in 22 patients. Thirty cases were smokers. There were 35 cases with diaphyseal fractures and 10 cases with metaphyseal fractures. There were 30 cases with open fractures, 22 patients were treated by intramedullary nail, and 18 patients by plate and screws, while the other 5 patients were previously treated conservatively. The mean follow-up period was 26 ± 5.7 months. The mean defect was 8.16 ± 2.32 cm. The mean interval between the first and the second stage was 7.07 ± 0.79 weeks. The mean time of graft consolidation was 27.4 ± 6.76 weeks after the second stage. The average external fixation index was 1.5 months/cm. Sound union was achieved in 93.3%.The pin tract infection had occurred in all cases. There were residual limb shortening (15.6%), valgus ankle deformity (6.7%), loss of range of knee flexion (33.3%), and refracture (4.4%). No donor site morbidity in either iliac or fibular sites had occurred. Induced membrane technique with autogenous grafting is an alternative biological pathway proved to be effective in the treatment of infected nonunion of long bone of the lower limb with the added value of the use of free fibular graft in such cases.

Use of Custom-Made Antibiotic Coated Intra-Medullary Nail in Treatment of Infected Non-Union of Long Bones

Introduction: In cases of infected Nonunion of long bones Antibiotic coated nail provides mechanical support for the affected bone with delivery of high concentration of antibiotics for infection control and a conclusive environment for fracture healing. The aim of the study was to observe and study the treatment of infected non-union of long bones with antibiotic coated nailing in infection control and bony union. Material and Method: The study was conducted on 30 patients (male and female between the age of 18‑70 years). All patient on admission were subjected to detailed history, relevant investigations and thorough clinical examinations. Minimum follow-up period was 6 months. Radiological and blood investigations were done for infection control and bony union. Result: In the current study of 30 patients with mean age of 43.67 years, Infection control and bony union was achieved in 27 patients without any need for subsequent procedures. Current study provides an alternative to external fixation alone as a means of stabilizing non-unions while providing a high concentration of antibiotic locally for combating this difficult problem. Conclusion: The clinical results and final outcome after antibiotic coated I.M. nailing in infected nonunion of long bones are both satisfactory and reproducible as evident by the comparison of this present study with the previous literature available.

A prospective study of management of infected non-union of tibia using ilizarov technique: Our results & complications

Background: Treatment of patients with infected non-union of long bones, is one of the most difficult challenge in Orthopaedic surgery. The purpose of this prospective study was to evaluate functional outcomes, effectiveness and complications of Ilizarov technique in the management of infected non-union of tibia. Materials and Methods: Thirty patients, with infected non-union of the tibia, were managed by adequate debridement, resection of infected portion, and stabilization by Ilizarov frame with docking or corticotomy & bone transport as per standard protocol. The results of follow-ups were analyzed clinically and radiologically, using ‘Association for the Study and Application of Methods of Ilizarov (ASAMI)’ scoring system.Results: In present study, all fractures of tibia united completely without any persistent infection. Out of 30 patients, bone results were excellent in 19, good in 8, and fair in 3 patients. We didn’t observe any poor bone result. Functional results were excellent in 15, good in 11, fair in 3, and poor in 1 patient. The most common complication was pin tract infection (16 patients/53%), which was managed accordingly. There was no need of amputation in any patient of our study group after application of Ilizarov technique.Conclusion: Ilizarov technique is the wonderful one stage procedure to eradicate infection, achieve satisfactory bone union and better functional results in cooperative patients with infected non-union of tibia.

Study on management of infected nonunion of long bones by bifocal osteosynthesis of ilizarov’s principle with the limb reconstruction system

Infected nonunion is one of the most challenging limb threatening orthopaedic complications in sense of treatment and management where considerable morbidity are observed. Thus the patients are having social, financial, physical, and mental impacts Significant progress has been made in the management of infected nonunion in the last decade with appropriate pre-operative evaluation and treatment strategy. The main objective of this study to find out the effect of segmental transport in the management of infected, non-union of long bones by Ilizarov’s concept using the Limb Reconstruction System (LRS). A total of 16 cases included in this study where 14 and 2 were males and females respectively. All the infected non-union of long bones cases was included in this study. Bone healing and functional results were evaluated. Most of the patients are in between the age groups of 31 and 50. While observing the site of the non-union cases, femer found maximum with 9 cases followed by tibia and humerus with 6 and one cases respectively. Reunion was successful in all cases thereby 10 cases classified as excellent; 3, 2 and 1 cases as fair, good and poor respectively. In this study, three major complications including shortening, knee stiffness and axial deviation were observed during post operative and follow-up periods. The method of treatment of infected non-union by the monolateral external fixator with a predictable healing of non-union and control of infection is well shown in this study. Careful preoperative planning, appropriate surgical techniques and adequate follow-up, will definitely make this method a very successful one.

Evaluation of ilizarov in infected non-union of long bones

Evaluation of ilizarov in infected non-union of long bones

Management of Infected Nonunited Femoral Fracture With Large Bone Defects: A Technique

Background: Segmental defects created after debridement for infected nonunion of long bones can be managed by external fixation and bone grafting, bone transport, or microvascular free-tissue flaps. Distorted local anatomy with a cumbersome Ilizarov frame, recipient site complications, thrombosis, and graft failure are possible complications of trending treatment modalities. Our 2-staged novel technique offers a simpler, easier, lesser money and time-consuming procedure to combat one of the most difficult orthopedic problems. Patients and Methods: Between January 2012 and January 2014, 12 patients, all were male individuals, enrolled in a prospective study underwent a 2-staged operation for infected nonunited femoral fracture with large bone defects. The first stage included radical debridement and sequestrectomy with rush pin fixation to maintain alignment and medullary patency supported by biplanar or limb reconstruction fixator; the second stage included 4 corticocancellous bone graftings. Follow-up was for a duration of a mean of 24±3.4 months; the mean duration for full union was 9.36±1.6 months. Complications included knee flexion deformity managed by flexion deformity graft and pain at site by iliac crest graft. Conclusions: Our method of treatment presents a new approach for management of one of the most complicated orthopedic problems ever. Our method is economic, and cost and time saving, consuming less time and materials needed for the operation.

Comparision of Ilizarov Ring Fixator and Rail Fixator in Infected Nonunion of Long Bones: A Retrospective Followup Study.

Background:About 70 million trauma injuries that occur annually, around the world. More than 4.5 million open fractures occur per year in India. Long bone fractures nonunion (NU) rate varies from 2% to 7%. The management of open fracture is challenging for the orthopedic surgeon. The conventional protocol of management of compound fracture are debridement, temporary stabilization by external fixators, wound and definitive management. Very few prospective studies have been done comparing Illizarov and RF in infected nonunion. Thus we performed a retrospective study to compare the acceptance, complications, and functional outcome of Ilizarov ring fixator (IRF) and rail fixator (RF) in the treatment of infected NU.Materials and Methods:A retrospective cohort study of fifty infected long bone NU patients, who consulted Orthopedics Department of a tertiary care hospital of North-India from 2010 to 2014 was undertaken. Patients were divided into two Groups (Gp) of 25 each: one group was treated with IRF, another with RF and both followed for one year. Results were analyzed as per the ASAMI criteria (Association for the Study and Application of Methods of Illizarov) and complications as per Paley's classification. Patient's satisfaction was assessed by Visual Analog Scale (VAS) ranging from 0 to 100 mm.Results:Majority of the patients were in age group of 31- 45 years males with right sided involvement with previously treated infected NU of tibia involving distal one-third. According to VAS score, patients had mild to moderate pain in 13 cases in Gp-IRF and in 16 cases in Gp-RF, whereas severe pain was present in 12 cases of Gp-IRF and 9 cases of Gp-RF. Pin tract infection and pain were the commonest complication. Mean bone gap was 7.76 cm and 5.78 cm; average total treatment time was 17.64 and 13.40 months in Gp-IRF and Gp-RF, respectively. Duration of IRF application was more than RF (P < 0.01). Both the limbs were equated in 20 cases (80%) in Gp-IRF and 18 cases (72%) in Gp-RF. Results were found to be excellent in 7 (28%) and 8 (32%), good in 8 (32%) and 13 (52%), and fair in 10 (40%) and 4 (16%) cases in Gp-IRF and Gp-RF, respectively. Bony union achieved in 100% cases. Treatment index was 68.45 days/cm and 64.29 days/cm in Gp-IRF and Gp-RF, respectively.Conclusion:In view of the patient acceptance, functional outcome and complications, rail fixator shows a better result than Ilizarov.