Treatment of infected proximal tibial metaphyseal nonunions using the Ilizarov method: A prospective clinical study

BACKGROUND: Septic tibial nonunion regarding proximal metaphysis is a rare complication with devastating results. METHODS: Due to scarce literature about this condition, a prospective interventional study using Ilizarov External Frame was conducting with participants recruitment from December 2020 till January 2022. Primary outcomes were bone healing and infection eradication while side-effects were reported. Secondary outcomes were the final leg length discrepancy (LLD) more than 2.5 cm, external fixation time, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, the Knee Outcome Survey-Activity of Daily Living Scale (KOS-ADSL) score, the American Academy of Orthopedic Surgeons (AAOS) Lower Limb Scale, the quality-adjusted life year (QALY) Time Trade-Off and the Short-Form 12 (SF-12) physical and mental score. RESULTS: 17 patients (16 males) with infected proximal tibial nonunions were treated with an Ilizarov external fixator at the Orthopedic Department of Serres General Hospital in Serres, Greece. Fracture healing and infection eradication were achieved in all patients with minimum follow-up of 30 months. Tibia deformity was present in four cases (23.5%), and length discrepancies were observed in one patient (3 cm). Limping was recorded in three patients. Stiffness of the knee or ankle was reported in six patients but all patients except one were pain-free. Everyone resumed their work or daily activities. According to ASAMI, the bone results were excellent in 13 patients, good in three patients, and fair in one. Analogously, the functional results were excellent in 11 patients, good in two and fair in 4 patients. Patient Reported Outcome Measures (PROMs) display an impressive improvement over the observation period. CONCLUSION: The Ilizarov method is a reliable technique for managing septic proximal tibial metaphyseal nonunions, particularly in cases involving extensive bone loss and existing deformities. Of vital importance is the assembling of an experienced multidisciplinary team to manage these rare and complex clinical conditions. TRIAL REGISTRATION: ISRCTN30905788 (SePseT Ilizarov).