CHANGE OF METHOD IN THE TREATMENT OF NONU NIONS OF THE TIBIA COMPLICATED BY INFECTION AND BONE LOSS

Aim of investigation: The treatment of nonunions complicated by infect ion and bone loss is divided into two stages. Having calmed down the i nfection by stabilizing, removal of infected and necrotic tissue and l ocal antibacterial measures, the bone loss has to be filled up. Bridgi ng the gap by means of autogenous cancellous bone grafting is complica ted by a high rate of refractures depending on the length of bone loss . Therefore after changing the method and using the Ilizarov procedure it is of interest, whether this method offers advantages. Our experie nce is to be reported and discussed. Methods: According to the clinica l course two groups of patients with nonunions of the tibia complicate d by infection and bone loss were compared. 25 previously evaluated pa tients of the years 1980/81 whose tibial bone loss was bridged by canc ellous bone grafting (1st group) were compared with 16 patients who we re treated by the Ilizarov method from May 1990 to October 1993 (2nd g roup). The average age was nearly the same (32.6/32.9 years). In the f irst group the average of bone loss measured 4 cm, in the second 7.8 c m. The number of initial operations to eliminate infection and the dur ation of fixator application from the beginning of bridging bone loss were compared as well as early and late complications, especially the rate of refracture and reinfection. Results: 1.2 operations were neede d to eliminate infection in the first group, in the second only one wa s necessary. The handling of the Ilizarov device is more difficult and needs training. The higher rate of early complications at the beginni ng decreased with increasing experience. The average of fixation time could be reduced by about ten days per cm of bone loss using the Iliza rov technique. By segmental transport new cortical bone is generated w hich surpasses cancellous bone grafting in regard to stability. This s eems to be an important reason that refracture did not occur in the se cond group. Furthermore, reinfection could be avoided up to now obviou sly due to sufficient segmental resection of infected and necrotic tis sue. Limited stores of autogenous cancellous bone are not to be feared . The total number of operations can be reduced. At the docking side e arly single cancellous bone grafting is recommended.