Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect

Soo Kyung Lee; Jung Ryul Kim; Jong Han Lim; Jun Mo Lee

doi:10.12671/jkfs.2010.23.1.57

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Lee, Kim, Lim, and Lee: Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2010; 23(1): 57-63.

Published online: 31 January 2010

DOI: https://doi.org/10.12671/jkfs.2010.23.1.57

Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect

Soo Kyung Lee, M.D., Jung Ryul Kim, M.D., Ph.D., Jong Han Lim, M.D., Jun Mo Lee, M.D., Ph.D.

Department of Orthopedic Surgery, Medical School, Research Institute of Clinical Medicine, Chonbuk National Univeristy, Jeonju, Korea.

Address reprint requests to: Jung Ryul Kim, M.D., Ph.D. Department of Orthopedic Surgery, Medical School, Chonbuk National University, 634-18, Geumam-dong, Dugjin-gu, Jeonju 561-712, Korea. Tel: 82-63-250-1767, Fax:82-63-271-6538, jrkeem@chonbuk.ac.kr

Received 26 August 2009 Revised 10 September 2009 Accepted 28 December 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect.

Materials and Methods

36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method.

Results

Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015).

Conclusion

The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

Keywords: Tibia, Infected nonunion, Bone defect, Soft tissue defect, Ilizarov external fixator

Figures and Tables

Fig. 1

The 67 year-old male sustained comminuted open fracture of the right distal tibia and fibula (Gustilo III-c type) with soft tissue defect by traffic accident. External fixation was done, but delayed soft tissue coverage, then developed infected nonunion with chronic osteomyelitis according to Paley classification at postoperative 5 months.

(A) Roentgenograms showed nonunion tibia with soft tissue defect.

(B) The free flap of latissimus dorsi applied to soft tissue defect site.

(C) After radical excision of all necrotic tissue, applied bifocal Ilizarov frame with acute shortening of 6cm in length and inserted vancomycin beads.

(D) Follow-up study at eight months after operation with Ilizarov technique showed consolidation of regenerates and union of docking site.

(E) Roentgenograms fifteen months after operation showed excellent bone and functional result.

Fig. 2

The 27 year-old male sustained comminuted open fracture of the right tibia and fibula (Gustilo III-c type) with soft tissue defect by traffic accident. We couldn't check posterior tibial artery pulsation in ankle area. Closed reduction and external fixation was done, because unstable vital condition. Then developed infected nonunion with chronic osteomyelitis according to Paley classification at postoperative 3 months.

(A) Roentgenograms showed comminuted tibia and fibular fracture.

(B) Closed reduction and external fixation was done in emergency operation.

(C) Then developed infected nonunion with soft tissue defect after 3 months.

(D) After radical excision of all necrotic tissue, applied bifocal Ilizarov frame with acute shortening of 5 cm in length.

(E) Follow-up study at 10 months after operation with Ilizarov technique showed consolidation of regenerates and union of docking site.

(F) Roentgenograms 16 months after operation showed excellent bone result and good functional result.

Fig. 3

The healing index of proximal location show shorter than other site (p=0.038).

Fig. 4

The bone and functional result of proximal location show better than other site (p=0.025, p=0.03).

Fig. 5

The healing index of group A show shorter than group B (p=0.015).

Fig. 6

The bone and functional result of group A show better than group B (p=0.025, p=0.015).

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