Nonunion is a devastating complication of tibial fractures with a debilitating effect. Several studies
reporting tibial nonunions in adults are available; however, the reports on infected nonunions in children
are scarce. The purpose of this study was to evaluate the results of treating paediatric infected tibial
nonunion using Ilizarov
fixator without radical resection.
Materials and methods: The study included 36 cases with infected nonunion of the tibia with 31 males and
5 females, and an average age of 11.4 years. The mean number of previous operations was 3.5. The
duration before presentation averaged 10.4 months. At presentation, 24 cases were draining nonunions,
while 12 patients had quiescent sinuses. Preoperative shortening was evident in 31 patients ranging from
1 to12 cm. Six cases had equinus foot deformity. Stiffness of the ankle and/or knee was present in 11 cases.
Angular deformity of more than 10 was evident in 13 nonunions. The monofocal compressiondistraction
was used for 10 cases managed by bloodless technique, and four draining cases managed by
limited debridement and compression distraction. Limited debridement and bone transport was used in
the remaining cases including proximal chondrodiastasis (two cases), proximal tibial corticotomy (17
cases), and partial osteotomy (three cases).
Results: The mean follow-up duration was 51.9 months. The external
fixation period averaged 5.3 months.
Delayed union occurred in three cases treated by repeating compression-distraction. Eventually, union
was achieved in all cases. Two cases suffered refracture. Four cases had residual angular deformity of
about 5-7. Infection recurred in one case. ASAMI bone results were excellent in 29 patients, good in three
patients, fair in two patients, and poor in two patients. The ASAMI functional results were excellent in 27
cases, good in 5 cases, fair in two cases, and poor in two cases.
Conclusion: The Ilizarov method provides a viable treatment method for treating paediatric infected
nonunions in a single stage of management. Limited debridement was enough to control infection and
achieved good results without radical resection. |
