J Korean Orthop Assoc.  2022 Oct;57(5):400-408. 10.4055/jkoa.2022.57.5.400.

Treatment of Infected Nonunion of the Tibia and Femur Shaft Fractures with Classical Internal Bone Transport

• Kim H
• Shin YW

• KMID: 2534394
• DOI: http://doi.org/10.4055/jkoa.2022.57.5.400

Abstract

Purpose
This study analyzed the results of limb salvage surgery of classical internal bone transport using an Ilizarov apparatus for cases of infected nonunion of the lower extremity long bones, including the complications.
Materials and Methods
The data of the patients with infected nonunion of the femur or tibia treated with bone internal transport method using Ilizarov apparatus from December 2006 to December 2011 were reviewed retrospectively.
Results
Of the thirteen cases, eleven patients had a lesion of the tibia, one on the knee joint, and the last on the femur shaft. The average length of internal transport was 89.5 (42–191) mm with the external fixation period of 362.8 (175–601) days, resulting in the external fixator index of 1.43 (0.91–2.08) month/cm. The major complications were four cases of delayed union or nonunion, two cases of regenerate failure, two cases of limb length discrepancy of more than 2.5 cm, two cases of remnant angular deformity, one case of refracture, two cases of equinus deformity and ankle joint stiffness, and one case of intended knee joint fusion. In all thirteen cases, bone union was achieved without infection recurrence.
Conclusion
Limb salvage surgery using Ilizarov apparatus for classical internal bone transport could be a way to avoid amputation in patients with infected nonunion. The outcomes of classical internal bone transport with a higher bone union rate and lower infection recurrence were acceptable. On the other hand, all possible complications, the treatment course, and other options, such as bone transport with internal fixation or induced membrane technique, should be shared with the patient before surgery to enhance overall satisfaction. Furthermore, for difficulties in regenerate formation in the bone with osteomyelitis and massive bone defect, the patient should be informed of a potential longer fixation period or additional surgeries for regenerate failure, including bone graft or fibular transport, to facilitate the patient’s compliance to treatment.

Keyword

tibia; femur; wound infection; ununited fractures; Ilizarov technique