Purpose: End results analysis of surgical treatment of posttraumatic bone defects in the lower extremity by Ilizarov method and intramedullary nailing augmentation during consolidation.

Materials and method: Between 1990–2000,83 patients with posttraumatic bone defect (femur 26, tibia 57) with an average age of 38 years (11–65y.) were surgically treated. Open fracture was the cause of bone defect in 50 patients (60%). In the rest 33 (40%) patients, the bone defect was the result of a surgical removal of a nonviable bone due to osteomyelitis or infected non-union. The average length of bone defect was 8,5 cm. (4–20 cm.). In all cases corticotomy and application of Ilizarov device was necessary to initiate bone transport. In 26 patients the Ilizarov device was removed during consolidation and interlocking intramedullary nailing was performed. Selection criteria for changing method were: 1) delayed union at the docking site (13 pt.), 2) Intolerance of the Ilizarov device (6 pt.), 3) Angular deformity > 10 degrees (7 pt.). Radiological and clinical assessment was performed periodically. Functional recovery and bone healing were evaluated according to A.S.A.M.I criteria.

Results: Forty-eight patients (58%) presented delayed union at the docking site. In 35 patients compression- distraction was necessary to promote union. The rest 13 patients were healed using an interlocking intramedullary nailing. Three refractures needed reapplication of the Ilizarov device. Angular deformity of more than 10 degrees was found in 13 patients. Seven of them needed an osteotomy and intramedullary nailing. All bone defects were finally covered and solid bone formation resulted.

Conclusions: The Ilizarov method offers unique advantages in treatment of bone defects. The use of an interlocking intramedullary nail during consolidation, is a treatment option for delayed docking site union and prolonged treatment time.

Purpose: A clinical retrospective study of surgical treatment of chronic posttraumatic osteomyelitis by the Ilizarov method was conducted by analyzing the end results.The aim was to evaluate the efficacy of distraction osteogenesis in covering large bone defects and eradicate infection.

Materials and method: Between 1990–2000, twenty-one patients with chronic osteomyelitis were surgically treated. Inclusion criteria were: 1) active infection of more than six months and 2) bone defect (after the surgical debridement was completed) > 4cm.The average length of bone defect was 9,5 cm. (4–28cm.). In all cases corticotomy and application of the Ilizarov device was necessary to initiate bone transport.The protocol of the Association for the Study and Application of the Method of Ilizarov (A.S.A.M.I), was used to evaluate the results. All patients were examined clinically and radiographically in order to assess the proper alignment, the progress of bone healing and possible signs of infection.

Result: Thirteen patients (62%) presented delayed union at the docking site. In 4 patients compression –distraction was necessary to promote union. In 9 patients (43%) the Ilizarov device was removed and interlocked intramedullary nailing was performed after eradication of the infection was confirmed by clinical and laboratory data. Recurrence of infection occurred in one patient. Elimination of infection and solid bone formation was the end result for all patients. Two refractures at the docking site needed reapplication of an Ilizarov device. In one case angular deformity of more than 10 degrees needed correctional osteotomy.

Conclusions: The Ilizarov method addresses successfully infection, bone defect, deformity, and leg length discrepancy simultaneously. All these may coexist in difficult cases of chronic osteomyelitis. Complications associated specifically with bone transport in exceeded bone defects ,after radical resection of infected bone, include certainly delayed union or non-union at the docking site and prolonged treatment time.

Purpose: The purpose of this study was to evaluate the results of 23 patients with septic nonunion of the distal tibial metaphysis type Pilon fractures treated with Ilizarov technique.

Material and Methods: Between 1990 and 2002 the Ilizarov technique 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 (range16–68 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 non-unions 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 compression-distraction osteogenesis 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 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 technique is a reliable method in the treatment of metaphyseal septic nonunion of the distal tibia particularly in cases with angular deformity, ankle joint contracture and bone defects. Compliance of the patient is absolutely necessary.

We reviewed 13 patients with infected nonunion of the distal femur and bone loss, who had been treated by radical surgical debridement and the application of an Ilizarov external fixator. All had severely restricted movement of the knee and a mean of 3.1 previous operations. The mean length of the bony defect was 8.3 cm and no patient was able to bear weight.

The mean external fixation time was 309.8 days. According to Paley’s grading system, eight patients had an excellent clinical and radiological result and seven excellent and good functional results. Bony union, the ability to bear weight fully, and resolution of the infection were achieved in all the patients. The external fixation time was increased when the definitive treatment started six months or more after the initial trauma, the patient had been subjected to more than four previous operations and the initial operation had been open reduction and internal fixation.