Illizarov’s technique outcome in non-union tibial fracture

Anuranjan Dubey, Ashish Kumar Ragase


Background: Tibia being a superficial bone of the body and vulnerable to trauma, often becomes fractured among all long bone fractures. Tibial surface is subcutaneous most of its length so open fractures are common.

Methods: The present cross sectional study was conducted on 20 patients attending the outpatient department Of Orthopedics, Government Medical College and Hospital, Ambikapur, Sarguja (C.G) India between September 2020 to February 2021. Patients within the age group of 18-60 years, having fracture of any duration with gap non union and those having duration of fracture more than 36 weeks without bony gap were included in the study. Details of Patient’s characteristics concerning primary injury and treatment were recorded and evaluation of results were based on Paleys criteria.

Results: In bone/radiological results, seven were classed as excellent, eleven as good with the remainder of 2 being fair and poor each. Functionally nine were graded as excellent, nine as good and two as fair and poor each.

Conclusions: It was found that Ilizarov ring fixator is an excellent treatment modality for tibial non-union with infection. However the technique requires long treatment follow up. Multiple interventions may be necessary to overcome the difficulties which come across the treatment.


Ilizarov, Tibial non union, Osteomyelitis, Bone and functional score

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Lerner RK, Esterhai JL, Jr, Polomano RC. Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation. Clinical Orthop Relat Res. 1993;295:28-36.

Lawlis GF, McCoy CE. Psychological evaluation: Patients with chronic pain. Orthop Clin North Am. 1983;14:527-38.

Praemer A, Furner S, Rice DP. Musculoskeletal Conditions in the United States. Park Ridge, IL, American Academy of Orthopaedic Surgeons. 1992;83-124.

Terry CS, James B. Tibial shaft fractures. In: Campbell’s Operative Orthopaedics. Eleventh edition. Mosby Elseivier. 2008;3118.

Zura R et al. Treatment of chronic (>1 year) fracture nonunion: Heal rate in a cohort of 767 patients treated with low-intensity pulsed ultrasound (LIPUS). Injury, Int. J. Care Injured 46 (2015) 2036-2041.

Müller ME, Allgöwer M, Schneider R. Manual of Internal Fixation: Techniques Recommended by the AO Group. Berlin, Springer-Verlag. 1979;299.

Effect of time to definitive treatment on the rate of 86 SECTION 1 _ Section Title nonunion and infection in open fractures. J Orthop Trauma. 2002;16:484-90.

Gustillo RB. Management infected fractures. Surgery of musculoskeletal system. C McCollister Evart 2nd editon. 1990;5:4429.

Paley D. Current techniques of limb lengthening. J Pediatr Orthop. 1998:8;7-92.

Cattaneo R. The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clinical Orthopaedics and Related Research. 1991;280:143-52.

Hosny G, Shawky MS. The treatment of infected non-union of the tibia by compression-distraction techniques using the Ilizarov external fixator. International Orthopaedics (SICOT) (1998) 22:298–302.

Farmanullah, Khan MS, Awais SM. Evaluation of management of tibial non-union defect with Ilizarov fixator. J Ayub Med Coll Abbottabad. Jul-Sep 2007;19(3):34-6.

Rastogi D, Meena S, Sharma V, Singh GK. Epidemiology of patients admitted to a major trauma centre in northern India. Chinese Journal of Traumatology. 2014;17(2):103-7.

Piwani, Mehtab, et al. "Evaluation of AO external fixator in the management of open diaphysial fracture of tibia gustilo type IIIA and IIIB." Gomal J Medical Sciences. 2015;13:1.

Schwartsman V, Schwartsman R. Cortcotomy. Clinical Orthopaedics and Related Research. 1991;280:37-47.

Toh CL, Jupiter JB. The infected nonunion of the tibia. Clin Orthop Relat Res 1995;315:176–91.

Baruah R. Accordion Manoeuvre with Ilizarov Frame over Nail in Situ in a Case of Infected Non-Union of Femur: Discussion on Strategies: A Case Report. Open Journal of Orthopedics. 2014;4:183-8

Madhusudhan TR, Ramesh B. Outcomes of Illizarov ring fixation in recalcitrant infected tibial non-unions – a prospective study. Journal of Trauma Management and outcomes. 2008;2(6):1-9.

Garcia E. Circular External Fixation in Tibial Nonunions. Clinical Orthopaedics and Related Research. 1991;283:116–22.

Green SA, Jackson JM, Wall DM, Marinaw H, Ishkanian J. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop. 1992;280:136 .

Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the ilizarov circular fixator. J Bone Joint Surg [Br] 1996;78-B:710-7

Maini L. The Ilizarov method in infected nonunion of fractures. Injury. 2000;31(7):509-17.