title: Two stage reconstruction versus bone transport in management of resistant infected tibial diaphyseal nonunion with a gap.
abstract: BACKGROUND
  Infected nonunion of the tibial diaphysis poses one of the most challenging scenarios. There is no clear cut guidelines for cases of infected diaphyseal nonunion with bony defects of ≤6 cm.
  
  
  METHODS
  A retrospective comparative study was conducted on 30 patients who sustained resistant infected tibial diaphyseal nonunion with bony defect of ≤6 cm. The 30 patients were the sum of two groups; group I (16 patients, mean age 33.6 years) which included all patients, who underwent two stage reconstructions, and Group II patients (14 patients, mean age 29.5 years) who were managed by application of Ilizarov ring external fixator in a single stage surgery. Union was judged both clinically and radiologically. A scoring system comprising dual functional and bony grading was employed to evaluate the final results of both groups.
  
  
  RESULTS
  The results of both groups regarding the size of the resultant bony defect, the time to union, and the postoperative limb length discrepancy showed no statistically significant differences. Group II patients needed postoperative plastic reconstruction procedures significantly more than group I patients (p = 0.019). Similarly, group II patients exhibited more complications than group I patients (p = 0.003). Regarding both clinical and bony grading, the results of group I showed superiority to group II results with the only significant difference being the preservation of the preoperative range of motion of both ankle and subtalar joints (p = 0.072).
  
  
  CONCLUSIONS
  The use of two stage reconstruction in cases of resistant infected tibial diaphyseal nonunion gives comparable results to the Ilizarov ring external fixator in cases associated with bony defects within the confines of 6 cm with superiority in preservation of ankle and subtalar joints range of motion.
authors.affiliation: Orthopaedic Surgery Department, Minia University Hospital, Minia, Egypt. sadek_orthop@yahoo.com.
authors.forename: Ahmed Fathy
authors.initials: AF
authors.lastname: Sadek
authors.affiliation: Orthopaedic Surgery Department, Minia University Hospital, Minia, Egypt.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Laklok
authors.affiliation: Orthopaedic Surgery Department, Minia University Hospital, Minia, Egypt.
authors.forename: Ezzat H
authors.initials: EH
authors.lastname: Fouly
authors.affiliation: Orthopaedic Surgery Department, Minia University Hospital, Minia, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elshafie
mesh_terms: D000328:Adult; D003646:Debridement; D018483:Diaphyses / Q000601:surgery; D016267:External Fixators; D005260:Female; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010019:Osteomyelitis / Q000601:surgery*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D055815:Young Adult
keywords: Bone transport; Infected nonunion; Tibial diaphyseal defect; Two stage reconstruction