A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia

INTRODUCTION: The purpose of this study was to assess a population of patients with nonunion of the tibia treated with the Ilizarov method in terms of achieved union rates and maintained union rates, determination of re-fracture factors, with a subsequent comparison of our findings with those reported in the available literature. MATERIALS AND METHODS: This study was a retrospective assessment of 102 patients with nonunion of the tibia treated with the Ilizarov method in the period 2008–2015. The assessed parameters were bone union achieved during treatment, duration of stabilization with an Ilizarov external fixator, and maintained bone union at the last follow-up visit. RESULTS: The mean age at the start of treatment was 46.7 years (11–84 years). The mean follow-up period was 7 years (2–12 years). Bone union was achieved in all patients. The mean duration of Ilizarov stabilization in the study group was 7.9 months (2.8–20.7 months). The rate of union maintained at the last follow-up visit was 95.1%. CONCLUSIONS: All patients in our study achieved bone union, which constitutes a better outcome than those reported on average in the literature (73.7–100%). The mean length of time which the Ilizarov external fixator was in place in our patients was 8.3 months, which is consistent with the data from literature. Infection, atrophic nonunion, nonunion in 1/3 distal of tibia, and close surgery technique are risk factors of re-fracture. None of the analyzed studies assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.