Introduction: Infected nonunion of the femur with associated bone
loss represents one of the most difficult problems in orthopedic
practice. The purpose of this study was to evaluate the mid-term
treatment outcome of the Ilizarov technique in infected nonunion of
the femur.
Patients and Methods: This is a retrospective study of 24 patients
with infected nonunion of the femur treated by Ilizarov external
fixator. The mean age of patients was 37.71 years. The study included
19 males and five females. Eighteen patients (75 %) had draining
sinuses while six (25 %) were quiescent. Four cases had associated
deformity, and 18 patients had preoperative shortening with a range
of 1-6 cm. Failed previous surgeries ranged from 2 to 7 times and the
mean duration of nonunion was 28.75 months.
Results: Monofocal technique was used in eight patients, and bifocal
technique was used in 16 patients. All fracture nonunions were fully
united with mean fixator period of 12.75 months. The average followup
duration was 50.88 months. Persistent infection occurred in two
cases after frame removal and managed by further debridement. Two
cases had residual valgus deformity and two other patients had 2.5 cm
shortening. According to ASAMI criteria, the bone results were
evaluated as excellent in 19 patients, good in four patients, and fair in
one patient. The functional results were excellent in 18 patients and
good in six patients.
Conclusion: In spite of the several problems, obstacles, and
complications that may occur with the long treatment course, the
Ilizarov fixator was effective in treating the difficult disabling
problem of infected nonunion of the femur. |
