A Prospective Observational Study on Efficacy of Ilizarov External Fixation in Infected Non-Union Tibial Fractures

Author(s): Avinash Gundavarapu1, Vishal Singh2, Prashant Kumar Mishra3, Santhosh Kumar M.4

Open fractures and fractures caused by high-energy trauma are likely to get
infected and result in non-union. Infected non-union of long bones is a problem
in developing countries like India. Ilizarov external fixator was employed to
correct all the complications associated with non-union such as bone gap,
infection, shortening, and deformities. Stable fixation, corticotomy and bone
transport was employed to reduce or eliminate infection at the same time
achieving bone union and correction of limb length discrepancy. Our study
assesses the efficacy and safety of Ilizarov external fixation in patients with
infected non-union tibial fractures.
A series of 30 patients with infected non-union of tibia were treated with Ilizarov
external fixation in Yashoda super speciality hospital and regularly followed-up
between May 2014 and April 2016 (2 years). Bony and functional results were
estimated and correlated with existing studies.
Out of thirty patients treated, bony results were excellent in 17 patients, good in
8 patients, fair in 4 patients and poor in 1 patient. Functional results were
excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3
patients. Average duration of the fixator period was 8.1 months (min - 3 months,
max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max
- 6 cm). Average lengthening index in the study was 2.09 months / cm. Our
study in all 4 categories of Association for the Study and Application of Methods
of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and
functional results.
In our study results have been encouraging in addressing all the complex
problems by Ilizarov principle. Ilizarov external fixator system is the best device
to treat infected non-union of tibia. Distal third of tibia is more prone for
infection and non-union. Corticotomy or bone grafting is required for
augmentation of the healing process. Almost all patients had varying degrees of
oedema and pin track infections. Infection was controlled in all the cases and
bony union was achieved, no patient had persistence of non-union and infection
at the end of 2 years.