Ilizarov segmental bone transport of infected tibial nonunions requiring extensive debridement with an average distraction length of 9,5 centimetres. Is it safe?

• Published in: Injury 2021-08, Vol.52 (8), p.2425-2433
• Main Authors: Kinik, Hakan, Kalem, Mahmut
• Format: Article
• Language: English
• Subjects: Debridement; Distraction osteogenesis; External fixation index; External fixation time; Ilizarov external fixator; Infected non-union; Large bone defect; Tibia
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.12.025

•Radical debridement, irrigation, antibiotic cement bead application and Ilizarov bone transport is a safe treatment for infected tibial non-unions even in larger defects of a mean 9 cm distraction requirement.•In contrary to the literature; routine bone graft of the docking site is not needed in our series with open docking protocol.•Although the defect and distraction sizes are larger, the complication rates are not different from the average of other studies. To evaluate the results of one stage radical debridement and segmental bone transport with circular fixator in the treatment of infected tibial non-union requiring extensive debridement with an average defect size of 8 cm and distraction length of 9,5 cm. Retrospective study. Level I trauma centre at an academic university hospital. Thirty patients with infected tibial non-union with an average of 2,9 previous failed operations after a mean 12,5 months post-injury were treated consecutively. The mean age was 39,5 years (R:16–68). After radical debridement and irrigation, all patients were treated with segmental bone transport using Ilizarov circular fixator. All patients except 3, managed with an open docking protocol without bone grafting. In 2 patients a planned ankle arthrodesis with transport was done. Bone union, resolution of infection, external fixation index (EFI), external fixation time (EFT), bone and functional results for this big defect size. Union and eradication of infection was achieved in all patients. Mean follow-up was 32,5 months (R: 12–72 mo.) The average bone defect after debridement was measured 8.1 cm (R, 6–15). The total distraction length to restore the debridement defect and previous LLD was 9,5 cm (R, 6–15). The mean external fixation time was 13,7 months; the mean external fixation index was 1,49 mo./cm. One non-union, one refracture and one late valgus deformity was managed successfully with plating or nailing and all were healed uneventfully at the completion of the treatment. According to Paley & Maar and Katsenis criteria, the bone results were excellent in 24 and good in 6, functional scores were excellent in 21, good in 7, and fair in 2 patients. Minor complications were 1,36 per patient, major complications were 0,4 per patient and permanent complications were 0,2 per patient in the study group. In the management of large post-infectious bone defects requiring an average 9,5 cm distraction; segmental bone transport is safe in terms of union and eradication of inf