title: Ilizarov bone transport combined with antibiotic cement spacer for infected tibial nonunion.
abstract: OBJECTIVE
  To evaluate the curative effect of Ilizarov bone transport combined with antibiotic cement spacer for infected tibial nonunion with bone defect.
  
  
  METHODS
  We retrospectively reviewed the outcomes of 58 patients with infected tibial nonunion from January 2008 to March 2011 at our institution. Patients were treated with complete debridement, radical sequestrectomy, antibiotic cement spacer implantation, bone transport using the Ilizarov external fixator, and soft tissue reconstruction. Clinical efficacy was assessed using Paley's grading system and patient satisfaction at the last follow-up.
  
  
  RESULTS
  Follow-up ranged from 24 to 63 months (average, 31.6 months). Mean size of the tibial defect was 9.2 cm (range, 6-15 cm). The soft tissue defect was closed successfully in all cases. Patients eventually achieved union with a mean bone union index of 1.2 months/cm at an average of 10.6 months (range, 8-31 months). In terms of Paley grade, 30 patients had excellent results, 23 good, and 5 fair. Functional results were excellent in 28 patients, good in 18, and fair in 12. Thirty-five patients felt extremely satisfied, 18 satisfied, and 5 acceptable with the functional outcome. Complications included pin site infection in 18 cases, limb length discrepancy less than 1.5 cm in 10, knee stiffness in 5, equinus deformity in 4, infectious recurrence in 1 and pin breakage in 1. There was no refracture at the reconstruction site.
  
  
  CONCLUSIONS
  Ilizarov bone transport combined with antibiotic cement spacer is a versatile and effective method for treatment of infected tibial nonunion.
authors: Department of orthopedics, West China Hospital, Sichuan University Sichuan, People's Republic of China.
authors: Jing
authors: J
authors: Peng
authors: Department of orthopedics, West China Hospital, Sichuan University Sichuan, People's Republic of China.
authors: Li
authors: L
authors: Min
authors: Department of orthopedics, West China Hospital, Sichuan University Sichuan, People's Republic of China.
authors: Zhou
authors: Z
authors: Xiang
authors: Department of orthopedics, West China Hospital, Sichuan University Sichuan, People's Republic of China.
authors: Fuguo
authors: F
authors: Huang
authors: Department of orthopedics, West China Hospital, Sichuan University Sichuan, People's Republic of China.
authors: Chongqi
authors: C
authors: Tu
authors: Department of orthopedics, West China Hospital, Sichuan University Sichuan, People's Republic of China.
authors: Hui
authors: H
authors: Zhang
keywords: Ilizarov bone transport; antibiotic cement; bone defect; infected tibia nonunion