The Use of Ilizarov Method as A Salvage Procedure in Management of Infected Nonunion of the Tibia with Bone Loss

Backgroud: Nonunion of the tibia associated with infection has always been challenging and difficult to treat. Open contaminated high energy fractures, extensive surgical exposure with devitalization of bone fragments and the use of bulky internal fixation were implicated in the development of infected nonunion. Radical debridement of infected devitalized bone and soft tissue is needed to enhance bone union. Patients managed with conventional methods have multiple operations. The functional outcome may be unsatisfactory because of residual leg length discrepancy, deformity and the psychologic problems of prolonged treatment and repeated surgeries. Patients and Methods: Thirty two patients with infected nonunion of the tibia were treated with Ilizarov method of distraction osteogenesis after radical debridement of necrotic bone. There were 27 male (84.4%) and 5 female (15.6%) with average age 36.3 years (range 21 to 68). Twelve patients (37.5%) were heavy smokers. The nonunion occurred after high energy trauma; road traffic accident in 24 patients (75%) and fall from height in 8 patients (25%), resulting in open fracture in 30 patients (93.75%) and closed fracture in 2 (6.25%). Results: Bony and functional results were assessed using the criteria described by Paley and Maar. The bone results were graded as excellent in 25 patients (78.125%), good in 6 (18.75%) and fair in 1 patient (3.125%). The functional results were excellent in 21 patients (65.625%), good in 8 (25%), fair in 2 (6.25%) and poor in 1 patient (3.125%). Conclusion: The Ilizarov method of distraction osteogenesis is very effective in treatment of infected nonunion with bone loss. The Ilizarov fixator offers a good option for the patients with infected nonunion who were unable to bear weight for a long period of time as it is inherently stable even in patients with osteoporotic bone, it allowed correction of deformity, shortening resulting from the nonunion, and correction of associated problem of joints contracture.