title: The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method.
abstract: The purpose of this study was to demonstrate the effectiveness of the Ilizarov method and circular external fixator in order to eradicate the infection and restore bone union, limb anatomy and functionality in cases with infected nonunion of the tibia following intramedullary nailing. During 7 years nine patients suffering from infected nonunion of the tibia after intramedullary nailing were treated in our department. The series comprised seven men and two women with an average age of 39.7 years (range 21-75 years). The patients had previously undergone an average of 4.8 operations (range 3-6 operations). Active purulent bone infection occurred in all nine patients. Bone defect was present in all patients with a mean size of 5 cm (range 2-12 cm). In three cases with bone defect less than 2 cm, monofocal compression osteosynthesis technique was used. In the rest cases where bone defect exceeded 2 cm, bifocal consecutive distraction-compression osteosynthesis technique was applied. Three patients required a local gastrocnemius flap. The mean follow-up period was 26.6 months (range 13-42 months). Results were evaluated using Paley's functional and radiological scoring system. Bone union was achieved in all nine patients without recurrence of infection during the follow-up period. Bone results were graded as excellent in five cases and good in the rest four cases. Functional results were graded as excellent in three cases, good in four and fare in two cases. Mean external fixation time was 187.4 days (range 89-412 days) and mean lengthening index was 32 days/cm (range 27-39 days/cm). Complications observed included eight grade II pin tract infections, axial deformity at the lengthening site in two cases and at the nonunion site in another two cases. Ankle joint stiffness was detected in five cases. The Ilizarov method may be an effective method in infected nonunions of the tibia following intramedullary nailing.
authors.affiliation: Department of Orthopaedic Surgery, Medical School, University of Patras, Patras, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Megas
authors.forename: Alkis
authors.initials: A
authors.lastname: Saridis
authors.forename: Antonis
authors.initials: A
authors.lastname: Kouzelis
authors.forename: Alkiviadis
authors.initials: A
authors.lastname: Kallivokas
authors.forename: Spyros
authors.initials: S
authors.lastname: Mylonas
authors.forename: Minos
authors.initials: M
authors.lastname: Tyllianakis
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult