Distraction osteogenesis with conventional external fixator for tibial bone loss

Between 1991 and 2002, we treated 21 patients with tibial bone loss using a conventional external fixator. Nine patients had an infected open fracture and 12 patients an infected nonunion. After corticotomy, the bone was distracted at the rate of 1 mm (1 mm/step) on alternate days or every 48 h. The mean follow-up period was 18.7 (6-108) months after fixator removal. The mean new bone gained was 7.4 (2-17) cm. The mean healing index was 44.7 (17-86) days/cm. Total wound infection was resolved in 19 limbs (90.5%), and 11/12 (91.6%) nonunions united. Union with acceptable alignment (< 7 degree of angulation) and limb-length difference (<2.5 cm) was achieved in 18 limbs (85.7%). The bone result was excellent in 17 tibiae, good in three, and poor in one. Eighteen limbs had an excellent and three a good functional result. This modified technique of distraction osteogenesis using AO/ASIF conventional external fixator is safe, cost effective, and a versatile tool in the management of tibial bone loss associated with infected nonunion and open fractures.