A treatment for large defects of the tibia caused by infected nonunion: Ilizarov method with bone segment extension.

OBJECTIVES: To investigate the efficacy of the Ilizarov technique with bone segment extension in tibial infected nonunion.

METHODS: From September 2003 to June 2011, we treated 30 patients (21 males, 9 females; age 19-49 years, mean 34.1 years) for tibial infected nonunion with bone defects. Eleven cases were compound fractures internally fixed with steel plates, nine were compound fractures internally fixed with IM Nails, eight were compound fractures externally fixed with external fixation devices, and two were closed fractures internally fixed with steel plates. All 30 patients underwent debridement followed by the Ilizarov technique using bone segment extension.

RESULTS: After follow-up of 12 months-6 years (mean 29 months), stable union of fracture was achieved in all 30 patients. The time from bone fracture to union was 6-24 months, mean 8.8 months; external fixation was in place for 8-14 months, mean 10 months. External fixation index was 41 days/cm. Complications were three cases of pin site infection, one skin allergy, two fractures malunion, one early mineralization and one wire breakage. There were no cases of deep infection, nonunion or stiffness of the knee joint. According to the Paley fracture healing score criteria, 30 cases had excellent outcomes and two were good.

CONCLUSIONS: The Ilizarov technique with bone segment extension is effective in treating tibial infected nonunion with large bone defects.