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Infected nonunion of the tibia.

D Ring1, J B Jupiter, B S Gan

  • 1Department of Hand Surgery, Massachusetts General Hospital, Boston, USA.

Clinical Orthopaedics and Related Research
|December 28, 1999
PubMed
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Comparing Ilizarov technique and bone grafting for infected tibial nonunions, this study found both effective with well-vascularized tissue. Bone grafting showed better outcomes, while Ilizarov technique is suited for specific nonunion types.

Area of Science:

  • Orthopedic Surgery
  • Regenerative Medicine
  • Trauma Surgery

Background:

  • Infected nonunited fractures of the tibia present complex challenges in limb reconstruction.
  • Both Ilizarov technique and autogenous cancellous bone grafting are utilized for treating these defects.

Purpose of the Study:

  • To compare the efficacy of the Ilizarov technique versus autogenous cancellous bone grafting for infected tibial nonunions.
  • To evaluate outcomes in relation to soft tissue envelope quality and defect characteristics.

Main Methods:

  • A comparative study of 27 patients with infected tibial nonunions and bony defects (average 3.7 cm).
  • Group 1: Ilizarov technique (10 patients).
  • Group 2: Autogenous cancellous bone graft with soft tissue coverage (17 patients), often involving flaps (71%).

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Main Results:

  • At 6-year follow-up, 26/27 patients achieved a functional limb; one Ilizarov patient required amputation.
  • Three patients in each group needed secondary procedures for union.
  • Persistent infection occurred in four patients, all in the Ilizarov group.

Conclusions:

  • Autogenous cancellous bone grafting is safe and effective, especially with a well-vascularized soft tissue envelope (e.g., post-flap coverage).
  • The Ilizarov technique may be more appropriate for proximal/distal metaphyseal nonunions or those with significant leg length discrepancies.