The infected nonunion of the tibia

Ununited fracture of the tibia complicated by infection is not only a complex surgical problem but also a chronic and at times debilitating condition. The principle methods used to diagnose and stage posttraumatic tibial osteomyelitis are described. Infected nonunions of the tibia are characterized by the extent of bony loss and the presence of a functional ipsilateral fibula. Using this tibial staging criteria, a series of 37 infected nonunions of the tibia are reviewed. Twenty patients were male and 16 were female, with an average age of 33 years. The distal third of the tibia was involved in 19 patients, the middle third in 11, and proximal third in 7. Twenty three of the tibia were infected with > 1 organism. Thirty were Type 3 (tibial defect of 6 cm or less with a long and usable fibula), 4 Type 4 (tibial defect > 6 cm without usable fibula), and 3 Type 5 (tibial defect > 6 cm without usable fibula). The patients were evaluated at an average of 61 months after treatment. Union and eradication of infection were achieved in 35 of 37 patients. The results of the Health Impact Analysis suggest that the infected nonunion of the tibia represented a chronic and debilitating disorder with a lasting impact.