Infected Non-union of Tibia Treated with Ilizarov External Fixator: Our Experience

Abstract

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes. Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records were reviewed for union of bone, bone and functional outcomes and complications. Results: The most common organism for infection was identified to be Staphylococcus Aureus. At the time of final follow-up all patients had achieved union except two, one of whom had to undergo amputation due to non-union and sepsis. Majority of the patients had an excellent score as per ASAMI grading system for bone and function results. The most common complication noted was pin track infections. Conclusion: In our experience, Ilizarov external fixator is better suited for infected non-union of tibia because it can provide a stable mechanical environment, bone transport, correct deformities, and enable weight bearing and hence we recommend its use for the same.

Keywords: Ilizarov technique; bony union; infection; non-union of tibia.

Fig. 1:

Radiographs of Patient 1. (a) Pre-operative antero-posterior and lateral views showing tibial non-union. (b) Post-operative antero-posterior and lateral views after Ilizarov application. (c) Antero-posterior and lateral views at the time of final follow-up showing bony union.

Fig. 2:

Radiographs of Patient 2. (a) Pre-operative antero-posterior and lateral views showing tibial non-union. (b) Post-operative antero-posterior (top row) and lateral (bottom row) views after Ilizarov application. (c) Antero-posterior and lateral views at final follow-up showing bony union.

Fig. 3:

Comparison of outcomes as per ASAMI scoring system.