The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method

Megas, Panagiotis; Saridis, Alkis; Kouzelis, Antonis; Kallivokas, Alkiviadis; Mylonas, Spyros; Tyllianakis, Minos

doi:10.1016/j.injury.2009.09.013

« Previous Next »Injury
Volume 41, Issue 3 , Pages 294-299, March 2010

The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method

Panagiotis Megas
- Department of Orthopaedic Surgery, Medical School, University of Patras, Greece
- Orthopaedic Department, University of Patras, Rio Patras, Greece
Alkis Saridis
- Department of Orthopaedic Surgery, Medical School, University of Patras, Greece
- Orthopaedic Department, University of Patras, Rio Patras, Greece
- Corresponding author at: Orthopaedic Department, University of Patras, Pititsis and Kirpou 13, Rio Patras, T.K. 26500, Greece. Tel.: +30 6945776766/2610999937; fax: +30 2610994579.
Antonis Kouzelis
- Department of Orthopaedic Surgery, Medical School, University of Patras, Greece
- Orthopaedic Department, University of Patras, Rio Patras, Greece
Alkiviadis Kallivokas
- Department of Orthopaedic Surgery, Medical School, University of Patras, Greece
- Orthopaedic Department, University of Patras, Rio Patras, Greece
Spyros Mylonas
- Department of Orthopaedic Surgery, Medical School, University of Patras, Greece
- Orthopaedic Department, University of Patras, Rio Patras, Greece
Minos Tyllianakis
- Department of Orthopaedic Surgery, Medical School, University of Patras, Greece
- Orthopaedic Department, University of Patras, Rio Patras, Greece

Accepted 4 September 2009.

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 5cm (range 2–12cm). In three cases with bone defect less than 2cm, monofocal compression osteosynthesis technique was used. In the rest cases where bone defect exceeded 2cm, 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.

Keywords: Intramedullary nailing, Tibial nonunion, Ilizarov method, Osteomyelitis