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Infected nonunion of the tibia
1Department of Hand Surgery, Massachusetts General Hospital, Boston, USA.
Clinical Orthopaedics and Related Research
|December 28, 1999
Summary
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%).
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.