The treatment of infected tibial nonunion with aggressive debridement and internal bone transport

Tibial nonunions are a challenging situation for both healing and reconstruction when infection is added. In this retrospective study, we discuss the cases in which we had managed to obtain union by aggressive debridement, circular external fixature, and internal bone transport. Fourteen cases had been treated between January 1995 and December 2000 in the Orthopedics and Traumatology Department of the Gulhane Military Medical Academy. The mean follow-up period was 33.2 (12-60 months) months. The mean length of defects was 4.4 (2.5-8 cm) cm. These defects were repaired by corticotomy and by internal bone transport only. Pseudoarthrosis and union of corticotomy sites occurred in a mean period of 6.8 (4.5-15) months. In two of our patients, reinfection occurred, and hyperbaric oxygen therapy was applied to them. We concluded that in tibial infected nonunions, satisfactory union and control of infection are possible by radical debridement, stable fixation by circular external fixature, osteotomy and callus distraction, antibiotic therapy, and hyperbaric oxygen therapy whenever needed.