Introduction Refracture of the tibia after union is a challenging problem for the patients and the surgeons. The purpose of the
current study is to present our experience in conservative management of such patients with refracture of infected ununited
tibia after successful treatment by Ilizarov external fxator and bone transport.
Material and methods We reviewed the fles of 812 patients with infected ununited tibia who were treated by debridement,
corticotomy, and bone transport using Ilizarov methods in our institute between 1997 and 2017. Inclusion criteria were
patients with refracture after union and removal of the Ilizarov apparatus. Twenty-two patients with 23 refracture tibia were
included in the study. All the 23 tibias were treated conservatively by above knee cast that was converted to Sarmiento below
knee cast after early callus formation, except in the case of upper tibial fracture that continued in above knee cast till union.
Afterwards, a protective splint was used for additional two months.
Results There were 19 males (86.4%) and three females (13.6%), the mean age of the patients was 38.39 years, the mean time
of Ilizarov external fxator application was 10.86 months (range, 6–17), and the mean time of refracture after fxator removal
was 2.33 months. Union was achieved in 19 tibias (82.6%), with a mean time of 7.2 months (range, 4–12). Complications
included fve cases of skin irritation that was treated by large windows in the cast and changing the casts more frequently,
three cases developed DVT (deep venous thrombosis), and axial deviation occured in four tibias (17.3%).
Conclusion Conservative treatment of refractured tibia after removal of Ilizarov external fxator following treatment of
infected non-union tibia by above knee cast is efective in achieving union. However, complications as skin irritation, DVT
(deep venous thrombosis), and axial deviation can be anticipated.
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