THE INFECTED NONUNION OF THE TIBIA

Ununited fracture of the tibia complicated by infection is not only a complex surgical problem but also a chronic and at times debilitating condition. The principle methods used to diagnose and stage posttrauma tic tibial osteomyelitis are described. Infected nonunions of the tibi a are characterized by the extent of bony loss and the presence of a f unctional ipsilateral fibula. Using this tibial staging criteria, a se ries of 37 infected nonunions of the tibia are reviewed. Twenty patien ts were male and 16 were female, with an average age of 33 years. The distal third of the tibia was involved in 19 patients, the middle thir d in 11, and proximal third in 7. Twenty three of the tibia were infec ted with >1 organism. Thirty were Type 3 (tibial defect of 6 cm or les s with a long and usable fibula), 4 Type 4 (tibial defect >6 cm with u sable fibula), and 3 Type 5 (tibial defect >6 cm without usable fibula ). The patients were evaluated at an average of 61 months after treatm ent. Union and eradication of infection were achieved in 35 of 37 pati ents. The results of the Health Impact Analysis suggest that the infec ted nonunion of the tibia represented a chronic and debilitating disor der with a lasting impact.