Abstract
Aims
To investigate a treatment algorithm of various Ilizarov methods in managing infected tibial non-union.
Patients and Methods
A consecutive series of 76 patients with infected tibial non-union were treated with one of four Ilizarov protocols, consisting of; monofocal distraction (25 cases), monofocal compression (18), bifocal compression/distraction (16) and bone transport (17). Median duration of non-union was 10.5 months (range 2–546 months). All patients underwent at least one previous operation, 36 had associated limb deformity and 49 had non-viable non-unions. Twenty-six cases had a new muscle flap at the time of Ilizarov surgery and 24 others had pre-existing flaps.
Results
Infection was eradicated in 74 cases (96.1%) at a mean follow-up of 42 months (range 8–131). Both infection recurrences were in the monofocal compression group. Union was achieved in 66 cases (86.8%) with the initial Ilizarov method alone. Union was highest amongst the monofocal distraction and bifocal compression/distraction groups, 96% and 93.8% respectively. Monofocal compression was successful in only 77.8% of mobile non-unions. Bone transport secured initial union in 76.5% with a 47% unplanned reoperation rate. However, following further treatment union was 100% in the bone transport group compared to 88.9% in the monofocal compression group. Six cases sustained a refracture, with 5/6 occurring in the monofocal compression group, representing a 27.7% refracture rate. ASAMI scores were also significantly lower for the monofocal compression group.
Conclusion
We do not recommend monofocal compression in the treatment of infected, mobile non-unions. Distraction (monofocal or bifocal) was more effective achieving higher rates of infection clearance, lower refracture rates and better ASAMI scores.
