Circular external fixation in tibial nonunions

Area of Science:

• Orthopedic surgery
• Limb reconstruction
• Traumatology

Background:

• Tibial nonunions present significant challenges in orthopedic practice.
• Previous treatments like internal fixation and autografting may fail, necessitating advanced techniques.
• Complex cases often involve bone defects and infection, requiring specialized management.

Purpose of the Study:

• To evaluate the efficacy of the Ilizarov method for complex tibial nonunions.
• To assess outcomes in patients with and without significant bone defects.
• To determine the success rate of bone healing, infection eradication, and limb length discrepancy correction.

Main Methods:

• The Ilizarov method, utilizing compression-distraction and subperiosteal corticotomy, was applied to 82 lower extremities.
• Patients were divided into two groups: 45 with tibial nonunions without bone defects and 37 with bone defects requiring intervention.
• Bone transport and secondary surgeries such as autografting and tibial nails were employed as needed.

Main Results:

• Bone healing was achieved in 39 of 45 nonunions without defects (mean 5.4 months) and in all 37 with defects (mean 15 months for bone transport).
• Infection was eradicated in all cases following necrotic bone removal and bone transport.
• Mean limb length discrepancy was 0.7 cm (no defect) and 2.03 cm (with defect); residual axial deviation and shortening were noted in the bone transport group.

Conclusions:

• Circular external fixation with the Ilizarov method is effective for complex tibial nonunions, especially after failure of other treatments.
• The technique successfully addresses bone defects and eradicates infection, although secondary surgeries are common.
• Patient adherence and understanding of the prolonged treatment duration and potential complications are vital for successful outcomes.