Date: Tue, 18 Jan 2005 00:31:51 +0500

From: Alexander Chelnokov

Subject: Tibial infected nonunion

Dear colleagues

The case was presented in the Russian ortho list. A male 27 years old sustained an open (GA-II) fracture of the tibial shaft. Plating was performed on admission. Early deep infection developed, so the plate was removed and a small wire Ilizarov ex-fix applied. A sinus persisted about 6 month, after removal of a small fragment soft tissues got closed. All seemed to be healing, but on x-ray prior expected hardware removal in Dec 2004 a nonunion was seen (attached). Wire tracts now look quiet. The patient walks with a cane. He is tired with 1.5 year of ex-fix and requests to do something.

What can be done for him?

THX in advance.

Best regards,

Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia

Date: Mon, 17 Jan 2005 22:40:57 -0600

From: Obremskey, William T

Tough problem. You could bone graft him and leave Ilizarov and compress or if he or you are tired of the Iliz, an aggressive option is to remove Iliz, bone graft and place reamed locked IMN and suppress w/ po antibiotics. It would allow weight bearing, but may require IMN removal. I believe the words of Ilizarov were "infection burns in the fire of regenerate" - or bony union.

WTO

Date: Tue, 18 Jan 2005 12:57:08 +0000

From: aobonedoc

Remove ex-fix and cast for short time to allow pin sites to heal. Return to OR, posterolateral bone grafting with or without intramedullary rodding.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
Arlington Heights, Illinois 60005