Clinical Research Of Ilizarov Method On Treatment Of Tibial Bone Defect And Infected Nonunion

Objective: Tibial bone defect and infected nonunion are commondisorders for the orthopedic trauma, often due to the high-energy injury,improper treatment, etc. It is a great challenge for the orthopedic surgeon,especially when the tibial nonunion associated with bone infection. Manyconventional methods have been applied to treat in this situation e.g. radicaldebridement, local flaps, bone grafting and vascularized bone transplants, etc.All have improved results but none has been able to fully solve this clinicalsituation. As the emergence and development of the Ilizarov technique and itsbasic theory, the modern medicine has been promoted greatly and thechallenging problems which can not be solved by traditional methods aresolved, such as bone deformities, bone nonunion, osteomyelitis, etc. In1963,Ilizarov first reported that Ilizarov technique was used in treatment ofnonunion and limb deformities. Long term medical, biologic, and engineeringbasic science research has led to the discovery of a general biologic lawgoverning the stimulation of tissue growth and regeneration: the law oftension-stress. Gradual and slow traction on living tissues creates stresses thatcan stimulate and maintain the regeneration of active growth of certain tissues.Slow and steady traction of tissues causes them to become metabolicallyactivated, result in an increase in the proliferative and biosynthetic function.Epithelial and connective tissue like bone has a strong regenerative ability.Under slowly and steady traction, the gap of bone segment transport will berepaired by regenerated bone, and the new regenerated bone whether structureor function are like with the original bone. Meanwhile, the blood vessels,nerves, muscle, fascia, are regenerated accordingly with the extension segmentof the bone. Bone was one of the important organs of the body which could constantly metabolism and growth. Bone also has repair, regenerative andremodeling capabilities, however, the incidence of nonunion was as high as5-10%.The high rate of nonunion after tibia fractured, due to its ownanatomical feature. The tibia is known to have a large subcutaneous borderand often tenuous blood supply; soft-tissue damage at the time of injury andfurther soft-tissue disruption during internal fixation can disturb the bloodsupply, with a detrimental effect on fracture healing. Nonunion usuallyaccompanied with some complications, such as muscle atrophy, osteoporosis,joint stiffness, pain and physical dysfunction etc, are often lead to greatpsychological and physical burden, and increasing the financial burden onpatients and society. In this study, retrospective studies of the24cases of tibianonunion after open fracture to investigation the clinical effect of Ilizarovmethod on treatment of tibial non-union.Method: From April2010to September2012,24cases of tibialnon-union were treated by Ilizarov technique associated with debridement andskin graft debridement or skin flap transplantation surgery. There were19males,3females, with the average age of36.5years, ranged from21to61years. There were left tibial non-union in13cases and right tibial nonunion in11cases. There were infected non-union9cases, non-infected nonunion15cases. The causes were traffic injury in18cases, crash in4cases, crushinginjury in2cases. According to Paley classification: there were type BⅠfor15cases, type B Ⅱ for8cases, type B Ⅲ for1case.The average bone defect was5.9cm (2to10cm).16cases were treated by bone segmental transportassociated with debridement and skin graft debridement or skin flaptransplantation surgery, and8cases were treated by Shortening-lengtheningmethod associated with debridement and skin graft debridement or skin flaptransplantation surgery. There are Ilizarov circular external fixator in18casesand unilateral external fixator in6cases.Results: All the patients were followed from6months to32months,with a mean followed-up an average of21months. Regular postoperativeX-ray examination to assess nonunion healing state, all the tibial nonunion were healing well with out of osteomyelitis. The mean healing time was10months (range from4to24months). The mean fixation time was11months(range from6to27months). The average healing index was1.67months/cm.The length of affected lower limb restored well, have no significant differencewith the contralateral side. There were8cases suffered postoperative pin tractinfection,1case suffered mal-union and3cases suffered primary ossification,6cases suffered skin traction pain,1case combine with ipsilateral femoralshaft fracture after bone segmental transport and lengthening. According to thePaley score,18cases were excellent,5were good and1was fair.Conclusion: Ilizarov technique associated with debridement and skingraft debridement or skin flap transplantation surgery is an effective way totreat the tibial non-union with bone defects, especially for infected non-unionhas unique advantages. It is a reliable and successful method to treat tibialnon-union after severe tibial fractures.