The Journal of Bone and Joint Surgery, Vol 77, Issue 6 835-846, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection
GK Dendrinos, S Kontos and E Lyritsis
First Orthopaedic Department, Athens General Hospital, Greece.
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.
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