Ilizarov technique in combination with bone grafting and ankle traction for treatment of periarticular nonunion at the distal tibia

Objective To evaluate the clinical efficacy of a combination of Ilizarov technique, bone grafting and ankle traction for treatment of nonunion of the distal tibia within 2 cm around the ankle joint. Methods A retrospective study was performed on the patients who had been treated at Department of Orthopaedics, Sir Run Run Shaw Hospital from September 2014 to January 2018 for nonunion of the distal tibia within 2 cm around the ankle joint. They were 8 men and 4 women, aged from 32 to 56 years (average, 41 years). Their injury was all unilateral, involving 5 left and 7 right ankles. They had all received internal fixation at other hospitals for 6 to 18 months. After we treated them simultaneously with Ilizarov technique, bone grafting and ankle traction, they could walk with crutches as soon as 3 days after surgery in some cases. Their affected limbs were then subjected to gradual weight-bearing walking until they could walk normally without any aid 3 to 6 months after surgery. Their postoperative ankle functions were evaluated according to the ankle-hindfoot scores of the American Orthopedic Foot and Ankle Society (AOFAS) system. Results The 12 patients were effectively followed up for 12 to 24 months (average, 19 months). All their incisions healed well with no incision or pin-tract infection. All their bone nonunions healed after circular external fixation for 12 to 36 weeks. Their AOFAS scores ranged from 75 to 96 points, showing good functional recovery of the ankle joint. Conclusion A combination of Ilizarov technique, bone grafting and ankle traction is an effective treatment for nonunion of the distal tibia within 2 cm around the ankle joint, leading to preservation of the ankle function and prevention of posttraumatic ankle osteoarthritis. Key words: Fractures, ununited; Bone grafting; Osteoarthritis; Ilizarov technique; Ankle traction