THE ILIZAROV METHOD IN NONUNION, MALUNION AND INFECTION OF FRACTURES

We have reviewed a series of 56 consecutive patients treated by the Il izarov circular fixator for various combinations of nonunion, malunion and infection of fractures, We used segmental excision, distraction o steogenesis and gradual correction of the deformity as appropriate. Tr eatment was effective in eliminating 40 out of 46 nonunions and all 22 infections, There were two cases of refracture some months after remo val of the frame, both of which healed securely in a second frame. Cor rection of malunion was good in the coronal plane but there was a tend ency to anterior angulation, often occurring in the regenerate bone ra ther than at the original fracture site, after removal of the frame, T his was associated with very slow maturation of regenerate bone in som e patients, occurring largely, but not exclusively, in those who smoke d heavily. Patients expressed high levels of satisfaction with the out come, despite relatively modest improvements in pain and function, pre sumably because their longstanding and intractable nonunion had been t reated, None the less, the degree of satisfaction correlated strongly with the degree of improvement in pain and function. We emphasise the importance of a multidisciplinary team in the assessment and support o f patients undergoing long and demanding treatment. The Ilizarov metho d is valuable, but research is needed to overcome the problems of dela yed maturation of the regenerate and slow or insecure healing of the d ocking site.