Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects

PURPOSE. To assess the Ilizarov technique in treating large infected tibial defects by resection of the infected focus, its acute compression, and gradual distant site lengthening. METHODS. 27 men (mean age, 39 years) with infected nonunion and large bone defects of the tibia underwent complete resection of the nonunion site, debridement, sequestrectomy, lavage, and Ilizarov ring fixator application. Patients underwent acute compression of the defect site, followed by distant site metaphyseal corticotomy for simultaneous lengthening. The mean length of resection was 10 (range, 6-17) cm. The mean follow-up was 27 (range, 25-39) months. RESULTS. The mean lengthening achieved was 10 cm, mean union time 6.3 months, and mean duration of consolidation 10.2 months. Functional results were excellent in 19 patients and good in 5. The union time was longer in older patients. CONCLUSION. Acute compression and simultaneous lengthening can be used safely for treatment of large bone defects in the tibia. This avoids secondary operations at the docking site and reduces the duration of treatment.