Abstract
Infected nonunion and malunion of tibial plateau are rare injuries with no standardized
protocols for treatment. This study assessed the outcome of chronic infected intra-articular
proximal tibial fractures with and without metaphyseal bone loss managed with the
Ilizarov ring fixator. A series of six patients of intra-articular infected nonunion
of the tibial plateau and two patients with malunited plateau with metaphyseal nonunion
were treated in a tertiary care hospital. Three of these eight patients had a metaphyseal
bone loss or bone gap after debridement and underwent internal transport with distal
corticotomy to obtain the bone length. The remaining five patients underwent static
ring fixation after correction of the articular deformity. Clinical evaluation was
done by Knee Society Score, Rasmussen radiological and Association for the Study and
Application of Methods of Ilizarov scores. All patients but one achieved union with
the ring fixator. The average follow-up was 33 months (range, 12–120 months). Average
time to achieve union was 11.5 months (range, 3–30). The scores were good in four
patients and poor in the rest four, out of which three had undergone internal transport.
Proximal tibia intra-articular infected nonunion and malunion with or without metaphyseal
bone loss can be treated successfully with the Ilizarov fixator. Malunion of the tibial
plateau has to be addressed in cases with varus alignment of the limb or articular
step-off of ≥ 5mm between the two tibial surfaces. Patients with associated metaphyseal
bone loss tend to have complications and take a longer duration to heal. Single-stage
treatment avoids intra-articular malunion and loss of limb alignment.
Keywords
nonunion - Ilizarov ring fixation - chronic infected intra-articular fractures of
proximal tibia
