Bone Transport with the Ilizarov External Fixator for Tibial Shaft Gap Non-Union: A Prospective Observational Study

Open Access

Abstract

Background: Tibial shaft gap non-union is a complex reconstructive condition that may be accompanied by infection, segmental bone loss, deformity, limb shortening, and functional impairment. Bone transport using the Ilizarov external fixator allows gradual reconstruction of the defect while providing stable fixation. Objective: To evaluate union, radiological and functional outcomes, infection control, external fixation parameters, and complications following Ilizarov bone transport for tibial shaft gap non-union. Methods & Materials: This concurrent descriptive observational study included 30 patients with infected or aseptic tibial shaft gap non-union treated at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, from July 2023 to March 2026. Radical debridement, metaphyseal corticotomy, circular Ilizarov fixation, and gradual bone transport were performed. Bone and functional outcomes were assessed using the Association for the Study and Application of the Method of Ilizarov criteria, while complications were categorized according to the Paley classification. Data were analysed descriptively. Results: The mean age was 34.7 ± 10.2 years, and 24 (80.0%) patients were male. The mean bone defect was 4.8 cm, while infected non-union was present in 18 (60.0%) patients. Union was achieved in 28 (93.3%) patients. The mean external fixation time was 10.2 months, the mean external fixation index was 1.4 months/cm, and the mean bone transport time was 76.4 days. Excellent or good bone outcomes were achieved in 26 (86.7%) patients, while excellent or good functional outcomes were achieved in 24 (80.0%). Primary infection eradication was achieved in 16 of 18 infected cases (88.9%), and final infection control was achieved in all infected patients after additional treatment. Superficial pin-tract infection occurred in 16 (53.3%), docking-site non-union requiring intervention in 4 (13.3%), knee flexion contracture in 6 (20.0%), and ankle stiffness in 8 (26.7%). No amputation was required. Conclusion: Ilizarov bone transport provided a high rate of union, satisfactory bone and functional outcomes, and effective limb preservation in tibial shaft gap non-union. Nevertheless, prolonged treatment and frequent manageable complications remained important limitations of the procedure.