Background: The treatment of infected nonunion requires radical debridement with stable fixation. Sever
soft tissue compromise of the nonunion site might interfere with radical debridement. This study discussed the outcome oftreatment of infected tibial nonunion with sever softtissue compromise by a cyclic
compression distraction technique using Ilizarov without radical debridement.
Methods: This study comprised 17 patients with unilateral infected tibial nonunion; 10 with diaphyseal
and 7 with metaphysial locations.Their mean age was 21.9 years. There were 12 males and 5 females. The
right side was affected in 11 patients and the left side in 6 patients. According toGustilo and Anderson
classification, all patients were grade III. The mean limb shortening was 1.3 cm. All patients were treated
initially in another institute by uniplanner external fixator with rotational skin flap done in 11 patients
and thiersch graft in 6 patients. One patient had common peroneal nerve affection. Distal circulation
was sufficient in all patients. None of our patients had chronic diseases. Two to three cycles of gradual
distraction compression were done. Each cycle consisted of distraction, followed by compression, then
distraction, and lastly compression. The mean follow up period was 29.35 months.
Results: Union was achieved in all patients at a mean time of 23.9 weeks. According to Hammer et al.;
there were 8 patients with grade 1, and 9 patients with grade 2. According to Johner and Wruhs’ criteria;
the outcome was excellent in 6 patients, goodin 3 patients, poor in 4 patients, and fair in 4 patients.
Complications had occurred as pin tract infection (47.1%), persistent discharging sinus (5.9%), and valgus
ankle deformity (11.8%). Refracture did not occur in any case till the final follow up.
Conclusion: Although debridement is essential in the treatment of infected tibial nonunion, it could harm
the limb in severe soft tissue compromise. Cyclic compression distraction by Ilizarov had a satisfactory
outcome in the treatment of such cases through enhancement of a biological environment to achieve
union. |
