Bridging the Gap: Managing Tibial Nonunion with LRS and Ilizarov Techniques
Author : Dr. Aravind Ravi Chanal, Dr. Sandeep V Gavhale, Dr. Sagar A Jawale, Dr. Susovan Mandal, Dr. Pranil Yadav and Dr. Vaibhav Jagtap
Abstract :
Introduction: Tibial nonunion poses significant challenges due to infection, deformity, and bone loss. External fixation using the Ilizarov Ring Fixator or Limb Reconstruction System (LRS) enables deformity correction, bone transport, and early mobilization.
Methods: We present a consecutive series of 20 adult patients with tibial nonunion (aseptic and infected) treated using Ilizarov or LRS at a tertiary trauma centre. Indications included hypertrophic, oligotrophic, atrophic nonunion, bone defects, and post-infective cases. Data were prospectively recorded and analysed retrospectively.
Outcomes: Primary outcomes were union and time to union. Secondary outcomes included ASAMI bone/functional scores, RUST scores, limb length discrepancy (LLD), infection control, and complications (per Paley classification).
Results: Union was achieved in 19/20 patients (95%), with a median union time of 28 weeks (IQR 20–40). Infection control was successful in all infected cases (9/9). ASAMI bone results were Excellent/Good/Fair/Poor: 6/12/1/1; functional results: 7/11/2/0. Mean residual LLD was 0.7 cm. Complications included 7 pin-tract infections (managed conservatively), 6 docking site nonunions (requiring bone grafting), 5 transient pain episodes, and 3 frame adjustments.
Conclusion: Both Ilizarov and LRS systems are effective in managing complex tibial nonunions, achieving high union and infection control rates. Success depends on meticulous debridement, stable fixation, and gradual correction.
Clinical Message: Master the biological and mechanical principles. Choose Ilizarov for complex deformities and bone transport, and LRS for simpler cases—while ensuring pin-site care and early rehabilitation.
Keywords :
Tibial Nonunion, Ilizarov Ring Fixator (or Ilizarov Technique), Limb Reconstruction System (LRS), External Fixation, Bone Transport.
