Posttraumatic Nonunion of the Distal Tibial Metaphysis. Treatment Using the Ilizarov Circular External Fixator

Ten nonunions of the distal tibial metaphysis were treated by using the Ilizarov circular external fixator. Original fractures were classified in terms of the Association for the Study of Internal Fixation as AO type A (4 cases), type B (5 cases), and type C (1 case). Six patients had a history of osteomyelitis. Bifocal compression-distraction lengthening osteosynthesis was performed in all cases. Proximal metaphyseal corticotomy was combined with resection and compression of the distal nonunion site in five cases, and compression alone in three patients. Ankle arthrodesis, in addition to nonunion resection, was performed in two patients. Follow-up averaged 48 months (range, 26 to 81). Eight nonunions healed (80%). Limb length was completely corrected in five cases; angular and rotational alignment was corrected to within 5 degrees in seven patients (70%). Based on an objective and subjective scale, the results were considered good-to-excellent in seven cases and poor in three. Despite the high complication rate and relatively low success rate (70%), the use of the circular frame with small-diameter, tensioned wires may provide an alternative method for the treatment of the very difficult problems associated with complex low distal tibial metaphyseal nonunions.