Treatment of post infection tibia bone defects with Ilizarov external fixation

Background: Infected bone defects in the lower extremity present significant challenges in orthopedic trauma, requiring a multidisciplinary approach involving thorough debridement, infection eradication, and complex reconstruction. While various techniques exist, including vascularized grafts and the Masquelet method, the Ilizarov external fixator (IEF) remains a primary modality for addressing segmental loss, though its application in resource-limited settings requires simplified diagnostic and therapeutic frameworks.

Objective: This article aims to present a simplified classification system for bone and soft tissue defects tailored for clinicians in low- and middle-income countries (LMICs) and to evaluate the clinical outcomes of various IEF techniques in managing infected tibial nonunions.

Key Points: A retrospective analysis of 43 patients with infected tibial shaft defects (average age 30 years) was conducted. The proposed classification categorizes defects as small (<3 cm) or large (>3 cm), integrating soft tissue status and host optimization. Surgical strategies included monofocal acute docking, bifocal or trifocal bone transport, and fibular transfer. All nonunion sites achieved consolidation within an average of 8.8 weeks, with total healing times ranging from 6 to 15 months. Complications included pin tract infections (n=9), ankle stiffness (n=15), and persistent mild drainage (n=10), though these did not preclude successful limb salvage. Biologic adjuncts such as bone marrow aspirate and bone morphogenetic proteins are also discussed as potential treatment enhancers.

Conclusion: The Ilizarov method is an effective and versatile treatment for infected tibial defects, allowing for simultaneous infection control, bone transport, and deformity correction. The simplified classification system facilitates rapid clinical decision-making in diverse surgical environments.