Treatment of infected nonunion of the juxta-articular region of the distal tibia

Abstract

Objective: The purpose of this study was to summarize our clinical results with distraction osteogenesis for the treatment of infected tibial nonunion around the ankle joint.
Methods: Between 1994 and 2009, 13 patients with a mean age of 50 years (range: 27–79 years) underwent tibial reconstruction for the treatment of infected nonunion of the distal tibia, with a mean bone loss of 4.8 cm (range: 1–7 cm). Lengthening over an intramedullary nail as a second procedure was used in 2 patients, bifocal compression and distraction technique in 5 cases, compression with Ilizarov external fixator in 5 cases, and Taylor Spatial Frame (TSF, Smith & Nephew, Memphis, TN, USA) in 1 case. At final follow-up, functional and radiographic results were evaluated according to Paley’s bone and functional healing criteria.
Results: Mean duration of follow-up was 36 months. Mean external fixation time was 198 days, and mean external fixation index was 29 days/cm. According to Paley’s bone healing criteria, there were 10 excellent, 2 good, and 1 poor result(s); additionally, according to Paley’s functional healing criteria, there were 5 excellent, 6 good, and 2 fair results. There were 11 problems, 5 obstacles, and 1 sequel according to Paley’s classification of complications. There was 1 persisting nonunion, which underwent revision with a retrograde intramedullary nail.
Conclusion: External fixator and/or combined treatment are effective and reliable methods to treat infected nonunion of the distal tibia. Every patient should be evaluated according to their infection level and bony defects for reconstruction.

Keywords

• Distal tibia; infection; juxta-articular; nonunion; reconstruction.