The Outcomes of Distraction Osteogenesis over an Intramedullary Nail for the Treatment of Bone Defects in Infectious Nonunions

Document Type : RESEARCH PAPER


1 Department of Orthopedic Surgery, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran



Objectives: The concurrent utilization of an external fixator and intramedullary nail (IMN) for segment 
transportation may potentially decrease the duration of external fixator implementation and reduce 
associated complications. This study aimed to report the outcomes of bone transport utilizing a 
combination of IMN and Ilizarov frame in a cohort of individuals who had tibia or femur critical -sized 
bone deficiency resulting from nonunion.
Methods: The present research used a single-arm clinical trial design to enroll a series of patients presenting with 
critical-sized bone defects resulting from infectious nonunion of the tibia or femur. The study was conducted during 
the period of 2017-2020 in a referral Orthopedic Surgery Center located in Tehran, Iran. The management of patients 
with infectious nonunion was carried out through two main stages, including infection eradication and bone 
transportation. The process of bone healing and segment transportation was evaluated by radiographic assessment 
throughout the follow-up period.
Results: A total of 39 patients with bone defects in the tibia (19 cases) or femur (20 cases) with a mean age of 
31.44 (±11.95, range=18-60) were included in this study. Twenty-nine (74.3%) patients had open fractures. The 
bone defect exhibited an average size of 6.31 ± 1.95 cm. The mean of the consolidation index (CI) was 0.97 
(range=0.51–1.32) mo/cm, and the mean of the external fixator index was 0.67 (range=0.41-1.10). Although the CI 
was longer in patients with open fracture compared to those with closed fracture, the difference was not statistically 
significant (P=0.353). After the end of the two-year follow-up, complete union was observed in 35 patients (89.7%).
Conclusion: Intercalary segmental bone transportation using the Ilizarov technique over an IMN, as well as 
preserving the advantages of the conventional callotasis method, reduces the complications of long-term use of the 
Ilizarov frame and increases patient adherence to treatment.
 Level of evidence: IV


Main Subjects

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