Modified Ilizarov technique for infected nonunion of the femur: the principle of distraction-compression osteogenesis.
OBJECTIVE
To evaluate the treatment outcome of the modified Ilizarov technique in infected nonunion of the femur.


METHODS
Between 1989 and 2002, records of 20 patients with infected nonunion of the femur treated with the modified Ilizarov technique were retrospectively reviewed. The modified Ilizarov frame was fixed after necrectomy of the dead infected bone and tissues. A proximal or distal corticotomy was performed following biological principles. For regeneration of gap, segmental transport was performed in 11 patients with a gap of more than 5 cm; acute docking followed by lengthening at the corticotomy site was performed in 9 patients with a gap of smaller than 5 cm. Mobilisation was started early with active participation of the physical therapist and the patients. Bone and functional results were measured and complications were categorised according to the Association for the Study and Application of the Method of Ilizarov guidelines.


RESULTS
The mean follow-up period was 62.8 months. Bony union and eradication of the infection was achieved in all patients except one who underwent amputation due to uncontrolled infection. Bone results were excellent in 13 patients, good in 4, fair in one, poor in one, and treatment failure (amputation) in one. Functional results were excellent in 3 patients, good in 9, fair in 3, poor in 4, and failure in one. A total of 71 complications occurred: 35 problems, 6 obstacles, and 30 true complications. The mean healing index was 38.3 day/cm (standard deviation, 1.6 day/cm).


CONCLUSIONS
The Ilizarov technique is a good salvage operation for infected nonunion of the femur. Limb salvage is preferable to prosthesis if the limb is viable, adequately innervated and the patient is mentally and financially committed to save the limb.
Krishnan
A
A
Department of Orthopaedics, Sheth KM School of PG Medicine and Research, Smt NHL Municipal Medical College, Ahmedabad, India.
Pamecha
C
C
Patwa
J J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D010012:Osteogenesis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology