Infected Nonunion of Tibia and Femur Treated by Bone Transport

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2015 Apr 19

PMID 25889513

Citations 47

Authors

Peng Yin

Lihai Zhang

Tongtong Li

Licheng Zhang

Guoqi Wang

Jiantao Li

Jianheng Liu

Jianfeng Zhou

Qun Zhang

Peifu Tang

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this study was to evaluate the effectiveness of the treatment of infected nonunion of tibia and femur by bone transport.

Material And Methods: We retrospectively reviewed 110 patients with infected nonunion of tibia and femur treated by bone transport. Our study included 92 males and 18 females with a mean age of 38.90 years. The site of infected nonunion involved 72 tibias and 38 femurs. The mean length of the bone defects after radical debridement was 6.15 cm (range 3-13 cm).

Results: The mean follow-up after removal of the apparatus was 23.12 months (14-46 months). Ten patients including seven patients with infected tibia nonunion and three patients with infected femur nonunion were lost to follow-up. All the patients achieved bone union, and no recurrence of infection was observed. The time of bone transport took a mean of 67.50 days (range 33 to 137 days), and the mean external fixation index was 1.48 months/cm (range 1.15-1.71 months/cm). According to Association for the Study and Application of the Method of Ilizarov (ASAMI) classification, bone results were excellent in 68, good in 28, fair in 12, and poor in 2; functional results were excellent in 37, good in 42, fair in 21, and no poor.

Conclusions: Our study and the current evidence suggested that Ilizarov methods in the treatment of infected nonunion of tibia and femur acquired satisfied results. Radical debridement is the key step to control bone infection.

Citing Articles

Cable-asisted bone transport versus circular external fixators-asisted bone transport in the management of bone defects of the Tibia: clinical and imaging results.

Alibakan G, Kanar M, Armagan R, Sulek Y, Altuntas Y, Eren O J Orthop Surg Res. 2025; 20(1):264.

PMID: 40069761 PMC: 11899003. DOI: 10.1186/s13018-025-05648-9.

Comparison of orthofix external fixator combined with vascularized fibula graft versus single segmental femoral lengthening for treating femoral defects ≥ 6 cm: a retrospective study.

Wumaierjiang Y, Hamiti Y, Yalikun A, Yusufu A BMC Musculoskelet Disord. 2025; 26(1):175.

PMID: 39979967 PMC: 11840988. DOI: 10.1186/s12891-025-08381-w.

Study of Factors Affecting the Clinical and Radiological Outcome in Management of Infected Non-Union of Tibia Managed with Ilizarov Ring Fixator and its Correlation with Patient-Reported Outcome: Prospective Descriptive Study.

Rathod A, Ramesh Krishna K, Sharath Kumar P Indian J Orthop. 2025; 59(2):231-238.

PMID: 39886269 PMC: 11775352. DOI: 10.1007/s43465-024-01326-w.

Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral Centre.

Tedeschi S, Rossi N, Zamparini E, Ambretti S, Mosca M, Faldini C Antibiotics (Basel). 2025; 13(12.

PMID: 39766570 PMC: 11672444. DOI: 10.3390/antibiotics13121180.

Optimizing bone transport strategies: a pixel value ratio-based evaluation of regeneration rates in bifocal and trifocal techniques.

Yang X, Hamiti Y, Liu K, Wang S, Kadier X, Xiong D Front Surg. 2024; 11:1494658.

PMID: 39720628 PMC: 11666508. DOI: 10.3389/fsurg.2024.1494658.

References

Magadum M, Basavaraj Yadav C, Phaneesha M, Ramesh L . Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects. J Orthop Surg (Hong Kong). 2007; 14(3):273-9. DOI: 10.1177/230949900601400308. View

Emara K, Allam M . Ilizarov external fixation and then nailing in management of infected nonunions of the tibial shaft. J Trauma. 2008; 65(3):685-91. DOI: 10.1097/TA.0b013e3181569ecc. View

Lei H, Yi L . One-stage open cancellous bone grafting of infected fracture and nonunion. J Orthop Sci. 1998; 3(6):318-23. DOI: 10.1007/s007760050059. View

Jain A, Sinha S . Infected nonunion of the long bones. Clin Orthop Relat Res. 2005; (431):57-65. DOI: 10.1097/01.blo.0000152868.29134.92. View

Rose R, Palmer W . The Illizarov method in infected non-union of long bones. West Indian Med J. 2007; 56(3):246-51. DOI: 10.1590/s0043-31442007000300011. View

Atesalp A, Komurcu M, Basbozkurt M, Kurklu M . The treatment of infected tibial nonunion with aggressive debridement and internal bone transport. Mil Med. 2002; 167(12):978-81. View

Yajima H, Tamai S, Mizumoto S, Inada Y . Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. Clin Orthop Relat Res. 1993; (293):256-64. View

Chaddha M, Gulati D, Singh A, Singh A, Maini L . Management of massive posttraumatic bone defects in the lower limb with the Ilizarov technique. Acta Orthop Belg. 2011; 76(6):811-20. View

Megas P, Saridis A, Kouzelis A, Kallivokas A, Mylonas S, Tyllianakis M . The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method. Injury. 2010; 41(3):294-9. DOI: 10.1016/j.injury.2009.09.013. View

10.

Minami A, Kasashima T, Iwasaki N, Kato H, Kaneda K . Vascularised fibular grafts. An experience of 102 patients. J Bone Joint Surg Br. 2000; 82(7):1022-5. DOI: 10.1302/0301-620x.82b7.10332. View

11.

Eralp L, Kocaoglu M, Rashid H . Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. Surgical technique. J Bone Joint Surg Am. 2007; 89 Suppl 2 Pt.2:183-95. DOI: 10.2106/JBJS.G.00306. View

12.

Abdel-Aal A . Ilizarov bone transport for massive tibial bone defects. Orthopedics. 2006; 29(1):70-4. DOI: 10.3928/01477447-20060101-10. View

13.

Feng Z, Yuan Z, Jun L, Tao Z, Fa Z, Long M . Ilizarov method with bone segment extension for treating large defects of the tibia caused by infected nonunion. Saudi Med J. 2013; 34(3):316-8. View

14.

Saridis A, Panagiotopoulos E, Tyllianakis M, Matzaroglou C, Vandoros N, Lambiris E . The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. J Bone Joint Surg Br. 2006; 88(2):232-7. DOI: 10.1302/0301-620X.88B2.16976. View

15.

Dendrinos G, Kontos S, Lyritsis E . Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. J Bone Joint Surg Am. 1995; 77(6):835-46. DOI: 10.2106/00004623-199506000-00004. View

16.

Madhusudhan T, Ramesh B, Manjunath K, M Shah H, Sundaresh D, Krishnappa N . Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions - a prospective study. J Trauma Manag Outcomes. 2008; 2(1):6. PMC: 2515289. DOI: 10.1186/1752-2897-2-6. View

17.

Arora S, Batra S, Gupta V, Goyal A . Distraction osteogenesis using a monolateral external fixator for infected non-union of the femur with bone loss. J Orthop Surg (Hong Kong). 2012; 20(2):185-90. DOI: 10.1177/230949901202000210. View

18.

Yin P, Zhang Q, Mao Z, Li T, Zhang L, Tang P . The treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator and a systematic review of infected tibial nonunion treated by Ilizarov methods. Acta Orthop Belg. 2015; 80(3):426-35. View

19.

Maini L, Chadha M, Vishwanath J, Kapoor S, Mehtani A, Dhaon B . The Ilizarov method in infected nonunion of fractures. Injury. 2000; 31(7):509-17. DOI: 10.1016/s0020-1383(00)00036-x. View

20.

Ring D, Jupiter J, Gan B, Israeli R, Yaremchuk M . Infected nonunion of the tibia. Clin Orthop Relat Res. 1999; (369):302-11. DOI: 10.1097/00003086-199912000-00032. View