Treatment of Gap Nonunion of the Tibia by the Ilizarov Method

Park, Hui Wan; Hahn, Soo Bong; Park, Young Joon; Yang, Kyu Hyun; Shin, Dong Eun; Park, Hong Jun

Abstract

Twenty four patients with gap nonunions of the tibia were treated with the Ilizarov intercalary bone transport method. The purpose of this retrospective study is to evaluate the results and complications in gap nonunions of the tibia treated using the Ilizarov method. There were 22 males and two females with an average age of the 35.8 years(range, 23-63 years). The mean follow up period was 30.2 months(range, 17-70 months). Ten of the 24 patients had no external shortening with bone gap, 13 external shortening with gap and one hemicircumferential defect. On average, the size of bone loss measured 8.2 cm(range, 3-18 cm). Twenty-one of 24 patients were treated by whole segment internal transport(fifteen were proximal fragment transport, five were distal fragment transport, one was proximal and distal fragment transport), one patient by anterior hemicircumferential corticotomy and partial bone fragment internal transport and tow patients by fibula transfer. All patients healed with solid bony union, although twelve patients required bone grafts, eleven at the docking site and one at the distraction site. On average, the healing index was 49 days/cm(range, 18-82 days/cm). There was on relationship between the percentage transport(size of the distraction gap/the transporting fragment length x 100) and healing index. Numerous complications were encountered, most commonly delayed union and pin site infection, Conclusively, the application of Ilizarov techniques to gap nonunions of the tibia was very effective, but required correct technique and careful follow-up examination.