Management of Infected Nonunion of Long Bones, A Case Series

Objective: To evaluate the management of long bones infected nonunion. Methods: This retrospective study was conducted between July 2014 and July 2017.  Inclusion criteria was to include all cases of infected nonunion of long bones with no evidence of union within six to eight months, irrespective of loss of bone. All patients were thoroughly investigated and evaluated clinically, labs and X-rays. All patients were assessed by the Association for the Study and Application of Methods of Ilizarov(ASAMI) criteria for radiological and functional outcomes. Results: In this study, Twenty cases of infected nonunion (tibia 14, and femur 6) were used. There were 14 males and 6 female subjects, for whom the average age was 35±6.21 SD (range 18-52). 15 patients had open fracture while 5 patients were post internal fixation. Infection was eradicated and the union was achieved in all cases. The average time to union was a mean of 10±1.1SD months, ranging from 8 to 12 months). The follow up was a mean of 18 months (range 16-20 months). In case of tibia and femur as per the ASAMI score, radiological results were excellent in 14/20 (70%) and good in 4/20 (20 %), 2/20 (10%) showed fair results and no patient had poor result. Functional outcomes were excellent in 13/20 (65%) subjects, 5/17 (25%) were rated as good, and 2/20 (10%) as fair. Union was achieved in all three cases of humerus. Conclusion: Infected non-unions pose challenge to both patient and surgeon. Ilizarov fixator gave good and excellent results in complex non-union of long bones by eradicating infection, filling the defect with bone transport and correcting the deformity.

[1]  Y. Sharma,et al.  Management of infected non-union of lower limb long bone fractures using ilizarov technique: a study of outcomes , 2017 .

[2]  Paras Kumar Banka,et al.  Treatment of Difficult Non-union of Long Bones using the Ilizarov Technique , 2017 .

[3]  Mohamed Nigm,et al.  Management of infected nonunions by using antibiotic-impregnated bone cement , 2016 .

[4]  H. Ullah,et al.  Outcome of ilizarov fixator in complex non-union of long bones. , 2015, JPMA. The Journal of the Pakistan Medical Association.

[5]  Z. Mao,et al.  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. , 2014, Acta orthopaedica Belgica.

[6]  S. Bansal,et al.  Role of Ilizarov ring fixator in infected non union tibia , 2014 .

[7]  Divesh Jalan,et al.  Management of nonunion of lower-extremity long bones using mono-lateral external fixator--report of 37 cases. , 2014, Injury.

[8]  J. Francis,et al.  Antibiotic cement impregnated nailing in the management of infected non-union of femur and tibia , 2013 .

[9]  L. Marais,et al.  Prevention and management of external fixator pin track sepsis , 2012, Strategies in Trauma and Limb Reconstruction.

[10]  D. Jain,et al.  Outcome in Patients With an Infected Nonunion of the Long Bones Treated With a Reinforced Antibiotic Bone Cement Rod , 2012, Journal of orthopaedic trauma.

[11]  Wei-Ming Chen,et al.  Successful Management of Infected Intramedullary Nailing With Reaming, Lavage, and Insertion of Antibiotic-Impregnated Cement Rods , 2011 .

[12]  G. Lovisetti,et al.  Bone Transport for Postinfectious Segmental Tibial Bone Defects With a Combined Ilizarov/Taylor Spatial Frame Technique , 2011, Journal of orthopaedic trauma.

[13]  H. M. Shah,et al.  Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions – a prospective study , 2008, Journal of trauma management & outcomes.

[14]  M. Bhandari,et al.  Infected Nonunion of the Long Bones , 2007, Journal of orthopaedic trauma.

[15]  R. Rose,et al.  The Illizarov method in infected non-union of long bones. , 2007, The West Indian medical journal.

[16]  J. Conway,et al.  Antibiotic Cement-Coated Interlocking Nail for the Treatment of Infected Nonunions and Segmental Bone Defects , 2007, Journal of orthopaedic trauma.

[17]  S. Patil,et al.  Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. , 2006, The Journal of bone and joint surgery. British volume.

[18]  K. Pande,et al.  Nonunion of the Diaphysis of Long Bones , 2005, Clinical orthopaedics and related research.

[19]  J. Ko,et al.  Infection after intramedullary nailing of the femur. , 2003, The Journal of trauma.

[20]  R. Simonis,et al.  Augmentative Ilizarov External Fixation After Failure of Diaphyseal Union With Intramedullary Nailing , 2002, Journal of orthopaedic trauma.

[21]  L. Yi,et al.  One-stage open cancellous bone grafting of infected fracture and nonunion , 1998, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[22]  Y. Inada,et al.  Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. , 1993, Clinical orthopaedics and related research.

[23]  D. Paley,et al.  Ilizarov treatment of tibial nonunions with bone loss. , 1989, Clinical orthopaedics and related research.

[24]  M. Park,et al.  The Treatment of Infected Non-union of Fractures of Long Bones , 1985 .

[25]  R. Gustilo.  Management of infected fractures. , 1982, Instructional course lectures.