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Joint German Congress of Orthopaedics and Trauma Surgery

02. - 06.10.2006, Berlin

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Treatment of septic nonunion of the distal tibial with the Ilizarov external device

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  • E. Lambiris - Orthopaedics, Patras University Hospital, Patras, Greece
  • N. Vandoros - Orthopaedics, Patras University Hospital, Patras, Greece
  • A. Karabasi - Orthopaedics, Patras University Hospital, Patras, Greece
  • M. Tyllianakis - Orthopaedics, Patras University Hospital, Patras, Greece

Deutscher Kongress für Orthopädie und Unfallchirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 92. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 47. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 02.-06.10.2006. Düsseldorf, Köln: German Medical Science; 2006. DocW.8.3-659

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgu2006/06dgu0890.shtml

Published: September 28, 2006

© 2006 Lambiris et al.
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Outline

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Purpose: To evaluate the results of treatment of septic nonunion of the distal tibial metaphysis with the Ilizarov external device.

Material and methods: Between 1990 and 2002 the Ilizarov fixator was used in 23 patients with posttraumatic infected nonunion of the distal tibia. Seventeen were males and 6 females. Average age was 40.1 years (range 16-68 years). Mean duration of nonunion was 13,8 months and the average number of failed previous surgical procedures 2.2. According to AO classification there were 3 nonunions with quiescent infection and no drainage, 4 with active infection and no drainage, and 16 with infection and drainage. The ankle joint was ankylosed in 6 patients preoperatively and it was painful in all patients. Thirteen patients had an angular deformity of more than 7 degrees (range 7-30 degrees, mean 16 degrees). Sixteen patients had a mean bone defect of 2.5 cm (range 1 to 6 cm). Monofocal or bifocal technique with or without bridging the ankle joint was performed in all cases. Ankle arthrodesis was necessary in 4 cases. Mean external fixation time was 139.6 days and mean follow-up period was 4 years.

Results: The results were evaluated using the functional and radiological scoring system described by Paley. The bone results were excellent in 7 patients (30.4%) good in 9 (39.1%) fair in 5 (21.7%) and 2 (8.69%) poor while the functional results were excellent in 4 patients (17.39%) good in 8 (34,8%), fair in 7 (30,4%) and poor in 4 (17,39%). Bone union and eradication of infection were achieved in all cases. Four bone defects required bone grafting and freshening at the docking site. Ankle motion was difficult to record preoperatively but good to very good ankle function was obtained at final follow up evaluation in 12 patients.

Conclusions: The Ilizarov method is the treatment of choice for septic pseudarthroses located at the distal tibial end where all other procedures face significant difficulties. In most of the cases, mobility of the ankle joint is well preserved. However, impaired ankle joint motion is the most common complication. In these cases joint arthrodesis may become inevitable.