AUGMENTATIVE ILIZAROV EXTERNAL FIXATION IN FAILED DIAPHYSEAL UNION FOLLOWING INTRAMEDULLARY NAILING

Abstract

To investigate the use of the Ilizarov circular fixator in treating diaphyseal non-union following previous intra-medullary nailing. The stability of each non-union was augmented using an Ilizarov fixator with nail retention.

We retrospectively reviewed nine consecutive patients (mean age 31 years, range 24–53 years) who were treated in our institution between 1993 and 1997 (mean follow up 19.2 months, range 6–33 months). Two femoral, three tibial and four humeral non-unions were included in the study. All patients were referred from other centers after failure to achieve bone union with intramedullary nailing. Patients who had non-union with other fixation devices in situ, those with active infection and those who had their non-unions explored at the time of fixator application were excluded from the study. The patients had undergone an average of 2.4 operations (range 1–5 operations) prior to fixator augmentation.

The circular fixator was applied over the nail as a closed procedure (non-union not surgically explored) in all nine patients. The non-union was manipulated either by compression or oscillation during fixator treatment. The mean duration of fixator treatment was 6.2 months (range 3–11 months).

Outcome measures assessed were bone union, deformity, shortening and functional outcome. Bone union was achieved in all nine patients. The bone results were graded as six excellent, one good and two fair. All patients reported a reduction in pain and satisfaction with their final outcome.

We recommend the use of the Ilizarov fixator with nail retention in resistant long bone union in carefully selected patients. This technique is particularly useful in the humerus where it avoids the morbidity associated with nail removal and plating. The augmentation method can shorten the fixator time and has the advantage of a simpler frame construct.