Infected nonunion of the tibia

The treatment of infected nonunited fractures of the tibia using the techni ques of Ilizarov was compared with autogenous cancellous bone graft applica tion under a well vascularized soft tissue envelope. There were 10 patients in the Ilizarov group and 17 in the bone graft group. Soft tissue coverage with a free vascularized or a rotational muscle flap was used more frequen tly among the patients having bone graft (71%) than the Ilizarov group (30% ). All 27 patients had bony defects (average, 3.7 cm; range, 1-18 cm), At a n average followup of 6 years, 26 patients had a functional limb, and one p atient (Ilizarov group) ultimately required a below knee amputation. Three patients in each group required a second plate and bone graft procedure to gain union. Infection persisted in four patients (all in the Ilizarov group ). If a well vascularized soft tissue envelope is present (particularly aft er flap coverage), bone grafting procedures are safe and efficacious. The I lizarov technique may be best suited for the treatment of very proximal or distal metaphyseal nonunions and nonunions associated with large leg length discrepancies.