Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing.

Objective: To investigate the use of the Ilizarov circular fixator and nail retention in treating diaphyseal nonunion following previous intramedullary nailing.

Design: Retrospectively reviewed, consecutive series. Mean duration of follow-up after achieving bone union: 19.2 months (range 6 to 33 months).

Setting: A tertiary referral center for nonunion surgery.

Patients: Nine patients (two femoral, three tibial, and four humeral nonunions) were included in the study. All patients were referred from other centers after failure to achieve union with intramedullary nailing. Patients who had nonunion with other fixation devices in situ, those with active infection and nonunion following nonoperative treatment, were excluded from the study. The patients had undergone an average of 2.4 operations (range 1 to 5 operations) before application of the Ilizarov fixator. All patients completed the study.

Intervention: The circular fixator was used to compress the nonunion site from without, retaining the intramedullary nail in each case. We excluded a patient who had his nonunion site explored followed by bone excision and transport. The mean duration of fixator treatment was 6.2 months (3 to 11 months).

Main Outcome Measurements: Clinical and x-ray evidence of bone union, infection, residual deformity, shortening, and assessment of functional outcome.

Results: Bone union was achieved in all nine patients using the circular fixator over the nail. The bone results were graded as six excellent, one good, and two fair. All patients reported a reduction in pain and satisfaction with their final outcome.

Conclusions: There is a role for the use of the Ilizarov fixator with nail retention in resistant long bone diaphyseal nonunion in carefully selected patients. This method can achieve high union rates where other treatment methods have failed.