Author(s): Jeejesh Kumar Thattan Kandyil1, Aneen Nambi Kutty2, Jouhar Kizhakke Thodika3
Tibial diaphyseal fractures commonly affect young males, and a severe fracture complicated by non-union or infection often results in employment loss or other social and economic problems. The goal of treatment should be a stable limb without deformation, of equal length, with functioning muscles, good range of joint motion, and free of pain. The Ilizarov external fixation technique is a valuable tool that enables achievement of these goals.
Aim of this study was to assess the functional and radiological outcome of Ilizarov technique for infected non-union of tibia.
MATERIALS AND METHODS
We selected 30 patients of infected nonunion tibia who presented to orthopaedic outpatient unit of Government Medical College, Kozhikode between 2011 July-2015 November. They were treated using Ilizarov technique and observed for a period of 2 years. Majority of cases in study group belongs to A and B-1 type of Paley’s classification. Bony and functional results were evaluated as laid down by the ASAMI criteria.
The average duration of fixation (treatment) was 6.6 months [range 5-10 months], average duration of union was 6.5 months. In the study, 80% had excellent to good results. ASAMI bone score and functional score were better in non-smokers. Persistent bone infection despite bony union was evident in 5 patients. 10 patients had residual shortening of more than 2.5 cm. There was limb oedema in many patients despite fracture union. After treatment, 13 cases had more than seven degrees. Significant limp was seen in 9 patients [30%]. After surgery, 12 patients’ [40%] stiffness persisted, with more than 15 degrees loss of range of movement. 5 patients got reflex sympathetic osteodystrophy or skin changes.
The Ilizarov technique with bone transport is the most versatile, adaptive and effective method of treatment of infected nonunion in tibia, and can very successfully deal with the associated large soft tissue and bony defects.