• Farman ullah
  • Muhammad Shoaib Khan
  • Syed Muhammad Awais


Background: Tibial bone defect lead to limb shortening and functional deficit and needs propertreatment. There are various treatment modalities for bone defect in long bone to restore lengthand function of the limb, i.e. bone grafting, vascularised bone graft, allograft and bone transport.Bone transport can be done through fixators (uniplaner or ring) and intramedullary nail system.This study was conducted on management of tibial non-union with Illizarov external fixator.METHOD: This descriptive study was performed on 58 patients in Agency Headquarter Hospital,Bajawar and Lady Reading Hospital, Peshawar, from January 2000 to January 2006. Patients ofeither gender with age between 9 to 58 years, having nonunion (clean and infected nonunion) intibia with defect of 2 to 7cm due to trauma or firearm injury were included in the study. Thesepatients were followed up upto one year. Outcome measures were according to the classificationof Association for the Study and Application of the Method of Ilizarov (ASAMI), which is basedon radiological (defect filling) and clinical (functional) findings. RESULTS: Out of 58 patients,44 (75%) were male and 14 (25%) were female. Mean age was 30 years (9 to 58 years). 38(65.52%) patients had infected non-union while 20 (34.48%) had clean non-union. Right tibia wasinvolved in 32 patients (51.17%) and left was involved in 26 (44.83%) patients. The cause ofinitial trauma was road traffic accident in 27 patients (46.55%), firearm injury in 23 patients(39.65%) and a simple fall in 8 patients (13.79%). The length of average bone defect was 2.90 cm(200-7.00cm). Radiological results were excellent in 33 (58.89%) patients, good in 12 (20.68%)patients, fair in 8 (13.79%) patients and poor in 5 (8.62%) patients. The clinical results wereexcellent in 33 patients (56.89%), good in 18 patients (31.05%), fair in 4 (6.89%) patients andpoor in 3 patients (5.17%). CONCLUSION: Ilizarov ring fixator is excellent treatment modalityfor tibial non-union with a defect, regarding bone union, deformity correction, infectioneradication, limb length achievement and limb function but this needs prolonged learning curvefor fresh orthopedic surgeons.Key words: Tibia; Nonunion; Bone Transport; Ilizarov fixator


Nicoll EA. Fractures of the tibial shaft. A survey of 705

cases. J. Bone Joint Surg Br 1964; 46:373-87.

Ellis H. The speed of healing after fract ure of the tibial

shaft. J. Bone Joint Surg Br 1958; 40-B(1): 42-6.

Bauer GC, Edwards P, Widmark PH. Shaft fractures of

the tibia. Etiology of poor results in a consecutive series

of 173 fractures. Acta Chir Scand 1962;124:386-95.

Edwards CC, Simmons SC, Browner BD, Weigel MC.

Severe open tibial fractures. Results treating 202

injuries with external fixation. Clin Orthop Relat Res

; 230:98-115.

Tucker HL, Kendra JC, Kinnebrew TE. Tibial defects.

Reconstruction using the method of Ilizarov as an

alternative. Orthop Clin North Am 1990;21(4):629-37.

Ilizarov GA: The principles of Ilizarov method. Bull

Hosp Joint Dis Orthop Inst 1988; 48(1):1 -11.

Ilizarov GA: The tension – stress effect on the genesis

and growth of tissues: Part I. The influence of stability

of fixation and soft tissue preservation. Clin Orthop

Relat Res 1989;238:249-81.

Ilizarov GA: The tension – stress effect on the genesis

and growth of tissues: Part II. The influence of the rate

and frequency of distraction. Clin Orthop Relat Res


Paley D Current techniques of limb lengthening. J

Pediatr Orthop 1988;8(1):73-92.

Paley D Catagni MA, Argnani F, Villa A, Benedetti

GB, Cattaneo R. Ilizarov treatment of tibial non-unions

with bone loss. Clin Orthop Relat Res 1989; 241:146-

Andersen LR, Johannsen HG, Ernst C, Weeth ER.

Tibial Pseudoarthrosis. Treatment using the Ilizarov

technique. Ugeskr Laeger 1996; 158(16):2237-40.

Most read articles by the same author(s)