An alternative method for the treatment of nonunion of the tibia with bone loss

Abstract

In this retrospective study we evaluated the method of acute shortening and distraction osteogenesis for the treatment of tibial nonunion with bone loss in 17 patients with a mean age of 36 years (10 to 58). The mean bone loss was 5.6 cm (3 to 10). In infected cases, we performed the treatment in two stages. The mean follow-up time was 43.5 months (24 to 96). The mean time in external fixation was 8.0 months (4 to 13) and the mean external fixator index was 1.4 months/cm (1.1 to 1.8). There was no recurrence of infection. The bone evaluation results were excellent in 16 patients and good in one, while functional results were excellent in 15 and good in two. The complication rate was 1.2 per patient. We conclude that acute shortening and distraction osteogenesis is a safe, reliable and successful method for the treatment of tibial nonunion with bone loss, with a shorter period of treatment and lower rate of complication.

A retrospective study of ilizarov fixation in infected non-union tibia: 36 cases

“…13 In our study we noted bone lengthening index i.e. duration required for formation of 1 cm of new bone was 1.48.…”

Outcome of distraction osteogenesis by ring fixator in infected, large bone defects of tibia

“…Such surgery may require a microvascular team and increase hospitalization time, cost, and morbidity. 7 We believe that if …”

“…Sen et al also reported that in patients with a soft-tissue defect, acute or gradual compression at the docking site allowed primary or delayed primary closure without any secondary reconstructive procedure. 7 There is less need for soft tissue coverage procedures in patients with bone transport, and this also decreases the need for surgery on other body areas for free tissue transfers. 19 El-rosasy also reported acute limb shortening and appropriate skin incisions to close the defect.…”

Nonunion of the tibia following intramedullary nailing treated by Ilizarov external fixator: A case report

“…Nonunion may present itself as a problem, though occasionally, following intramedullary fixation of the tibial fractures (Zelle et al, 2004;Patil and Montgomery, 2006;Sen et al, 2006). Too much or too little motion at the fracture site, excessive space between fracture fragments, inadequate fixation, infection, soft tissue interposition, inadequate blood supply, and many other factors can lead to nonunion (Shuler 1996;Rosen 1998;Audige et al, 2005;Drosos et al, 2006).…”