Bone Transport in Tibial Gap Non-Union—A Series of 25 Cases

Manish Kiran, Rabi Jee

Ninewells hospital, Dundee, UK; 2SCB Medical College, Cuttack, India.
SCB Medical College, Cuttack, India.

DOI: 10.4236/ojo.2012.24027                

Abstract

Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mean bone gap was 6.53 cm (range 4 to 12 cm). Union was achieved in all cases within a mean period of 11.12 months. The mean time taken for union, per centimeter of bone gap was found to be 1.7 months/cm. Pin tract infection was the commonest complication, seen in 9 cases (36%). The other complications encountered were neuropraxia (n = 3) deviation of the transported bone segment (n = 7), buckling of skin at the advancing side of bone (n = 4), traumatic corticotomy (n = 3), incomplete corticotomy (n = 1), equinus deformity (n = 4), knee stiffness (n = 4) and curling of toes (n = 4). The bone healing results were excellent in 92% of cases and good in 8% of cases. The functional results were excellent in 84% of cases, good in 12% and fair in 4% of cases. Thus bone transport by Ilizarov’s method manages the bone loss and the associated conditions with good bone healing and functional results.

Keywords

Tibial Gap Non-Union; Bone Transport; Ilizarov’s Method

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Paige Whittle, “Fractures of the Lower Extremity,” In: S. Terry Canale and H. B. James, Eds., Campbell’s Operative Orthopaedics, Mosby, Philadelphia, 2008, pp. 3117-3146.
[2]	D. Paley and D. C. Maar, “Ilizarov Bone Transport Treatment for Tibial Defects,” Journal of Orthopaedic Trauma, 2000, Vol. 14, No. 2, pp. 76-85. doi:10.1097/00005131-200002000-00002
[3]	D. Paley, M. A. Catagni, F. Argnani, A. Villa, G. B. Benedetti and R. Cattaneo, “Ilizarov Treatment of Tibial Nonunions with Bone Loss,” Clinical Orthopaedics and Related Research, Vol. 241, 1989, pp. 146-165.
[4]	M. Kiran and R. Jee, “Ilizarov’s Method for Treatment of Nonunion of Diaphyseal Fractures of the Humerus,” Indian Journal of Orthopaedics, Vol. 44, No. 4, 2010, pp. 444-447. doi:10.4103/0019-5413.69319
[5]	A. Farmanullah, M. S. Khan and S. M. Awais, “Evaluation of Management of Tibial Non-Union Defect with Ilizarov Fixator,” The Journal of Ayub Medical College Abbottabad, Vol. 19, No. 3, 2007, pp. 14-17.
[6]	A. S. Atesalp, M. Basbozkurt, K. Erler, A. Sehirlion?lu, S. Tunay, C. Solako?lu and E. Gür, “Treatment of Tibial Bone Defects with the Ilizarov Circular External Fixator in High Velocity Gunshot Wounds,” International Orthopaedics, Vol. 22, No. 6, 1998, pp. 343-347. doi:10.1007/s002640050274
[7]	B. Fleming, D. Paley, T. Kristianson and M. Pope, “A Biomechanical Analysis of the Ilizarov External Fixator,” Clinical Orthopaedics and Related Research, Vol. 241, 1989, pp. 241-295.
[8]	J. Aronson, B. H. Harrison, B. S. Stewart and J. H Harp, “The Histology of Distraction Osteogenesis Using Different External Fixators,” Clinical Orthopaedics and Related Research, Vol. 241, 1989, pp. 106-116.
[9]	A. E. Goodship and J. Kenwright, “The Influence of Induced Micromotion upon the Healing of Experimental Tibial Fractures,” Journal of Bone and Joint Surgery, Vol. 67, No. 4, 1985, pp. 650-655.
[10]	L. E. Lanyon and C. T. Rubin, “Static versus Dynamic Loads as an Influence on Bone Remodeling,” Journal of Biomechanics, Vol. 17, No. 12, 1984, pp. 897-907. doi:10.1016/0021-9290(84)90003-4
[11]	G. K. Dendrinos, S. Kontos and E. Lyritsis, “Use of the Ilizarov Technique for Treatment of Non-Union of the Tibia Associated with Infection,” Journal of Bone and Joint Surgery, Vol. 77, No. 6, 1995, pp. 835-846. doi:10.1097/01.blo.0000152369.99312.c5
[12]	S. Babhulkar, K. Pande and S. Babhulkar, “Non-union of the Diaphysis of Long Bones,” Clinical Orthopaedics and Related Research, Vol. 431, 2005, pp. 50-56.
[13]	L. Maini, M. Chadha, J. Vishwanath, S. Kapoor, A. Mehtani and B. K. Dhaon, “The Ilizarov Method in Infected Nonunion of Fractures,” Injury, Vol. 31, No. 7, 2000, pp. 509-517. doi:10.1016/S0020-1383(00)00036-X
[14]	A. P. Mehtab, M. A. Siddiqui and Y. H. Soomro, “Management of Infected Non-Union Tibia with Intercalary Bone Transport,” Pakistan Journal of Surgery, Vol. 24, No. 1, 2008, pp. 26-30.
[15]	G. D. Bobroff, S. Gold and D. Zinar, “Ten Year Experience with Use of Ilizarov Bone Transport for Tibial Defects,” Bulletin of the Hospital for Joint Diseases, Vol. 61, No. 3-4, 2003, pp. 101-107.
[16]	S. A. Green, J. M. Jackson, D. M. Wall, H. Marinow and J. Ishkanian, “Management of Segmental Defects by the Ilizarov Intercalary Bone Transport Method,” Clinical Orthopaedics and Related Research, Vol. 280, 1992, pp. 136-142.
[17]	A. M. Abdel-Aal, “Ilizarov Bone Transport for Massive tibial Bone Defects,” Orthopedics, Vol. 29, No. 1, 2006, pp. 70-74.
[18]	L. Naggar, F. Chevalley, C. H. Blanc and J. J. Livio, “Treatment of Large Bone Defects with the Ilizarov Technique,” Journal of trauma, Vol. 34, No. 3, 1993, pp. 390-393. doi:10.1097/00005373-199303000-00014
[19]	R. M. Thayur, R. Balasundaram, K. S. Manjunath, H. M. Shah, D. C. Sundaresh and N. Krishnappa, “Outcomes of Ilizarov Ring Fixation in Recalcitrant Infected Tibial Non-Unions—A Prospective Study,” Journal of Trauma Management & Outcomes, Vol. 2, No. 6, 2008, pp. 6-8. doi:10.1186/1752-2897-2-6