The Infected Tibial Nonunion Treated by Bone Transport

Objective To study the clinical outcomes of treating infected tibial nonunion using bone transport technique.Methods From October 2002 to October 2007,totally 45 patients(27 males,18 females) suffering from infected tibial nonunion were treated by radical debridement,compression and fixation of bone defect and shortening site with Orthofix LRS.Corticotomy was carried out in the tibial metaphysis combined with bone transport.The mean age of the patients was 38 years(range 10～55 years).22 patients were injured in road accidents,15 patients fell from high,and 8 patients were crashed by heavy things.The mean time from the injure to the operation was 14 months(range 6～21 years).Patients were underwent 2 to 7 operations,the average was 4.5.35 patients had bone defect and shortening,the mean shortening was 4.2 cm(range 2～8 cm).38 patients had cutaneous deficiency and bone revealed.Results All 45 patients got primary infection controlled,raw surface of soft tissue deficiency eliminated.One patient was bone nonunion again.One was bone union at the osteoectomy site ahead of achieving the prospective length.4 patients occurred pin track infection.None had the symptoms of the blood vessel and the nerve injury.The mean length of regenerating bone were 6 cm(range 2～9 cm).39 patients almost obtained the same length of the two lower extremities,but 6 still had shortening of 1.5～3 cm.The mean time of fixation period was 8 months(range 6～12 months).All patients got fine newly formed bone at the distraction site to achieve bone union.Conclusion The infected tibial nonunion can be successfully treated using the orthofix LRS external fixtor combined with internal bone transport technique.The infection control,raw surface eliminate and large bone defects can be treated on one operation with no bone grafting.