Mehtab A Pirwani, Aslam Siddiqui, Yunis H Soomro.
Management of infected non-union tibia by intercalary bone transport.
Pak J Surg Jan ;24(1):26-30.

Objective: To evaluate the efficacy of Ilizarov ring fixator in treating infected non-union tibia by intercalary bone transport. Design & Duration: Quasi experimental study from March 2004 to June 2006. Setting: Orthopaedics Unit II at Civil Hospital, Karachi. Patients: Sixteen patients, all males, aged 20-60 years (mean 32 years),with infected non-union tibia (Lax/Cierney Type IV Osteomyelitis); the commonest cause being open fracture and the commonest site being lower 1/3rd. Methodology: In infected non-union of tibia with draining sinus, wound swab was sent for culture and sensitivity, and sinogram done. Debridement and sequestrectomy was done, leaving behind a gap ranging from 2-8 cms (mean 4.5 cms) and Ilizarov ring fixator, a transport assembly, applied. A navigation wire was passed through medial malleolus, irrigation system set up and the wound closed in a single layer. Proximal metaphyseal corticotomy was done. Irrigation with 2-3 litres of normal saline with appropriate antibiotic was continued for five days. On the 5th day irrigation system was removed and the transport started. Patients remained on partial weight bearing till soft tissue healing occured. Transport took place over the navigation wire at the rate of 1mm/day till docking achieved. Full weight bearing was allowed after soft tissue healing; knee and ankle physiotherapy was started from day one. Navigation wire was removed after 2-3 weeks of docking. Follow up ranged from 12-27 months (mean 16 months). Results: Union was achieved at the docking site in all the cases at the time of frame removal i.e. 8-13 months. The duration of union at docking site ranged from 3.5 months to 6 months (mean 4.5 months). Two patients needed bone graft at the docking site. The regenerate was broken in one case due to fall which was treated in cast. All the patients were satisfied except a 60 years old who had severe osteoarthritis of knee. Pin tract infection occurred on & off in all the patients; appropriate antibiotic was given. The infection subsided in all the cases except two in whom debride- ment was followed by application of a local flap. Conclusion: Intercalary bone transport by Ilizarov ring fixator is the treatment of choice for lax, infected non-union of tibia without leg length discrepancy.

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