Clinical and Functional Outcome of llizarov External Fixation in the Management of Infected Tibial Nonunion

Open Access

Abstract

Background: Background: Infected tibial nonunion is a difficult complication characterized by persistent infection, bone loss, deformity, instability, and impaired limb function. Ilizarov external fixation offers simultaneous infection control, stable fixation, bone transport, deformity correction, and functional restoration. Aim of the study: The study aims to evaluate the clinical and functional outcomes of Ilizarov external fixation in the management of infected tibial nonunion. Methods & Materials: This descriptive observational study included 40 consecutive adults with infected tibial nonunion treated with Ilizarov external fixation at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh, from July 2024 to June 2025. All patients underwent debridement, with acute docking, corticotomy, bone transport, or bone grafting performed as required. Clinical and radiological follow-up assessed union, eradication of infection, ASAMI bone and functional outcomes, weight-bearing status, deformity, limb-length discrepancy, and complications. Data were analyzed using SPSS and summarized as mean ± SD, frequencies, and percentages. Results: Among 40 patients, the mean age was 39.6 ± 10.8 years; 82.5% were male, 67.5% sustained road traffic injuries, and 77.5% had open fractures. Bone defects were present in 72.5%, while Staphylococcus aureus was isolated in 45.0%. Following Ilizarov treatment, radiological union was achieved in 90.0%, eradication of infection in 87.5%, and overall treatment success in 85.0%. Excellent-to-good ASAMI bone and functional outcomes were observed in 82.5% and 77.5% of cases, respectively. Pin-tract infection was the most frequent complication, occurring in 37.5% of cases. Conclusion: Overall, Ilizarov external fixation achieved high rates of bone union, eradication of infection, and favorable functional recovery in infected tibial nonunion, with mostly manageable complications. The technique appears to be an effective limb-reconstruction option for complex cases with bone loss, deformity, and chronic infection.