Limb Salvage in Massive Tibial Gap Nonunion: Outcomes of Tibialization of Fibula Using the Ilizarov Method

Open Access

Abstract

Background: Massive tibial gap nonunion presents a formidable limb salvage challenge, with tibialization of the fibula offering a biological reconstruction option. However, outcome data from the Bangladeshi population remain limited. Objective: To evaluate the union rate and functional outcomes of tibialization of the fibula using the Ilizarov method for massive tibial gap nonunion. Methods & Materials: This prospective observational study was conducted at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh, Dhaka, from January 2021 to December 2025. A total of 25 patients with massive tibial gap nonunion underwent tibialization of the fibula using the Ilizarov method. Bone union and functional outcomes were assessed using standardized criteria. Data were analyzed using SPSS version 23.0. Results: Bony union was achieved in 88.0% of patients (n=22), with a mean time to union of 7.2 ± 2.4 months. Excellent functional outcomes were observed in 60.0% (n=15), good in 24.0% (n=6), and fair/poor in 16.0% (n=4). Pin site infection occurred in 24.0%, and minor complications in 16.0%. Conclusion: Tibialization of fibula using the Ilizarov method achieves satisfactory union rates and functional outcomes in massive tibial gap nonunion, with acceptable complication rates. This technique offers a reliable limb salvage option in resource-limited settings where microvascular reconstruction may not be available.