Clinical outcomes of Ilizarov external fixation in the management of infected tibial non-union: an observational study from Bangladesh

Background: Infected tibial nonunion involves persistent infection, impaired bone biology, mechanical instability, and often bone loss or deformity. Ilizarov fixation enables debridement, stable fixation, compression, and bone transport but may require prolonged treatment and carries frequent complications. Objective: To evaluate union, infection eradication, Association for the Study and Application of Methods of Ilizarov (ASAMI) outcomes, external fixation duration, and complications following Ilizarov treatment of infected tibial nonunion at a tertiary orthopaedic centre in Bangladesh. Methods: This observational study reviewed 37 adults treated at the Department of Orthopaedic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, from 1 July 2022 to 31 July 2025. Radical debridement, individualized Ilizarov fixation, and culture-directed antibiotics were used; bone transport was performed when required. Patients were followed for 12 months, with descriptive analysis based on last follow-up data. Results: Mean age was 33.7±11.4 years; 28 (75.7%) were men. Initial fractures were open in 25 (67.6%), and 15 (40.5%) had bone defects >2 cm. Union occurred in 34 (91.9%) after 5.8±1.4 months, and infection was eradicated in 33 (89.2%). Excellent/good ASAMI bone and functional outcomes occurred in 30 (81.1%) and 32 (86.5%), respectively. Mean external fixation duration was 7.4±1.5 months. Complications occurred in 28 (75.7%); pin-tract infection affected 16 (43.2%). One patient underwent amputation for persistent infection and sepsis. Conclusion: Ilizarov treatment achieved high observed union, infection eradication, and favourable ASAMI outcomes, but complications and prolonged frame treatment remained substantial.