الفهرس 
Title : Ilizarov Techniques in Management of Infected Post traumatic Tibial Nonunion with Bone Defect
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Abstract
ntroduction: Infected post traumatic tibial non-union with bone defect
managed properly by the Ilizarov method. The defect can be filled ASRL or by
bone transport (BT). We studied the functional and clinical outcome of ASRL
and BT in infected tibial nonunion with bone defect.
Materials and Methods: A prospective study was conducted in our department
from the data collected in the period between 2015 and 2017. There were 30
cases of infected non-union of the tibia, in patients of the age group more than18,
with a minimum two-year follow-up. group A consisted of cases treated by
ASRL (n=15), and group B, of cases by BT (n=15). The non-union following
both open and closed fractures had been treated by plate osteosynthesis, intramedullary
nails and primary Ilizarov fixators. Radical debridement was done,
and fragments stabilized with ring fixators. The actual bone gap and limb length
discrepancy were measured on the operating table after debridement. In ASRL
acute docking was done for defects up to 4cm, and bone transport docking for
gaps more than 4cm. Corticotomy was done in both groups and distraction
started after a latency of seven days. The time in external fixator, total cure time
and operation times of two groups were recorded. In addition, the total
complication incidence was recorded in both groups. removal of the ring fixator
after the clinico-radiological union.
Results: There was no significant difference in demographic data between
group A and B (p > 0.05) .The mean time to presentation was 15.1 months
ranging from 9 to 45.4 months in group (1) while in group (2) the mean time was
11.73 months ranging from 9 to 24 months with no statistical significant
difference between the both groups (p= 0.174). The mean bone gap was 3.33
Abstract
cm ranging from 2.5 to 4 cm in group (1) while in group (2) the mean bone gap
was 7.47 cm ranging from 5 to 13 cm. it was noticed that the bone gap was
statistically significant higher in group (2) compared to group (1) (p<0.001). The
external fixator time of group A and B was (4.5± 1.2) and (10.4 ± 3.7) months,
respectively (p < 0.001). External fixator index was 1.33± 0.2 in group A and
1.36± 0.36 in group B (p > 0.05). The number of additional operations in Group
A and B was (2) and (5) (p < 0.05). Total complication incidence in group A and
group B was equal (p > 0.05). Regrading bony ASAMI scoring and functional
ASAMI scoring there was no statistical significance between 2 groups (p= 0.69.,
p= 0.58)
Conclusions: Both techniques of ASRL and BT have good to excellent results in
cases with infected post- traumatic tibial nonunion with bone defect. the number
of complications and ASAMI scores for bone or function were not statistically
significant in the 2 treatment groups, however ASRL technique has a lower EFI,
and lesser interventions needed to union than BT group, due to smaller defects it
was used for, the docking site problems and the longer time for the transport in
BT group.
tibial non-union with bone defect managed properly by the Ilizarov method. The
defect can be filled ASRL or by bone transport (BT). We studied the functional and
clinical outcome of ASRL and BT in infected tibial nonunion with bone defect.
Materials and Methods: A prospective study was conducted in our department
from the data collected in the period between 2015 and 2017. There were 30
cases of infected non-union of the tibia, in patients of the age group more than18,
with a minimum two-year follow-up. group A consisted of cases treated by ASRL
(n=15), and group B, of cases by BT (n=15). The non-union following both open
and closed fractures had been treated by plate osteosynthesis, intra-medullary
nails and primary Ilizarov fixators. Radical debridement was done, and fragments
stabilized with ring fixators. The actual bone gap and limb length discrepancy
were measured on the operating table after debridement. In ASRL acute docking
was done for defects up to 4cm, and bone transport docking for gaps more than
4cm. Corticotomy was done in both groups and distraction started after a latency
of seven days. The time in external fixator, total cure time and operation times of
two groups were recorded. In addition, the total complication incidence was
recorded in both groups. removal of the ring fixator after the clinico-radiological
union.
Results: There was no significant difference in demographic data between Group
A and B (p > 0.05) .The mean time to presentation was 15.1 months ranging from
9 to 45.4 months in group (1) while in group (2) the mean time was 11.73 months
ranging from 9 to 24 months with no statistical significant difference between the
both groups (p= 0.174). The mean bone gap was 3.33 Abstract
cm ranging from 2.5 to 4 cm in group (1) while in group (2) the mean bone gap
was 7.47 cm ranging from 5 to 13 cm. it was noticed that the bone gap was
statistically significant higher in group (2) compared to group (1) (p<0.001). The
external fixator time of group A and B was (4.5± 1.2) and (10.4 ± 3.7) months,
respectively (p < 0.001). External fixator index was 1.33± 0.2 in group A and 1.36±
0.36 in group B (p > 0.05). The number of additional operations in group A and B
was (2) and (5) (p < 0.05). Total complication incidence in group A and group B
was equal (p > 0.05). Regrading bony ASAMI scoring and functional ASAMI scoring
there was no statistical significance between 2 groups (p= 0.69., p= 0.58)
Conclusions: Both techniques of ASRL and BT have good to excellent results in
cases with infected post- traumatic tibial nonunion with bone defect. the number
of complications and ASAMI scores for bone or function were not statistically
significant in the 2 treatment groups, however ASRL technique has a lower EFI,
and lesser interventions needed to union than BT group, due to smaller defects it
was used for, the docking site problems and the longer time for the transport in
BT group.