Management of complex non-union of shaft of tibia using Ilizarov technique and its functional outcome

Background: Complex non-union shaft of tibia is challenging to treat and it needs coordinated multidisciplinary team work. Ilizarov ring fixator is mainly used as a salvage option in treatment of complex non-union. We studied retrospectively the functional and radiological outcome of 21 complex non-union shaft of tibia, treated by radical debridement, Ilizarov ring fixator with compression and distraction osteogenesis. Methods: From 2008 to 2013, 21 cases of complex non-union shaft of tibia were included in our study. Eighteen patients were males and three patients were females with mean age of 37.5 years (19-56). The average number of surgeries before the index operation is 3.3 (1-5). Non-union was classified according to Paley's classification of non-union. All infected non unions were managed by radical debridement, fixed with Ilizarov ring fixator, monofocal / bifocal compression and distraction osteogenesis. The average duration of follow up is 45 months (30-70 months). The functional evaluation was done using ASAMI Scoring system, and bone union with serial radiographs. Results: All patients had successful union. The mean time for union was 7 months (5-9 months). The mean time for fixator removal is 10 months (7-14 months). The mean amount of regenerate is 3 cm (2-4 cm).Two patients had re-fracture, which united successfully after reapplication of Ilizarov frame. The complications were pin tract infection (90 pins out of 220 pins), pin loosening, skin maceration, and limb oedema. Using the ASAMI (Association for the study and application of the methods of Ilizarov) scoring system we obtained 10 excellent, 8 good, 2 fair, 1 poor functional results. Conclusions: The Ilizarov method is a viable option for complex non-union of shaft of tibia. The union was achieved successfully in all cases with good union and functional results, however, the results were compromised in cases, who underwent previous multiple surgeries before the index procedure. Thus the outcome can be improved if early osteosynthesis attempted with Ilizarov ring fixator in complex infective non unions.