42(6):634-641,2001 CLINICAL SCIENCES Treatment of Osteomyelitis and Infected Non-union of the Femur by a Modified Ilizarov Technique: Follow-up Study Vladimir Barbarossa, Branka R. Matkoviæ 1 , Nikša Vuèiæ 2 , Miroslav Bielen, Miroslav Gluhiniæ Department of Orthopedics, Holy Ghost General Hospital; 1 Zagreb University Faculty of Physical Education; and 2 Department of Internal Medicine, Holy Ghost General Hospital, Zagreb, Croatia Aim. To review the results of the management of chronic post-traumatic osteomyelitis and infected non-union with bone defects of femur using the Ilizarov technique with a modified apparatus assembly. Patients and Methods. Thirty patients treated by the Ilizarov method because of chronic fistulous osteomyelitis and in- fected pseudoarthroses of the femur were included in the prospective study between 1989 and 1999. Their mean age was 39.4±14.4 years (range, 25-80 years). The follow-up period lasted for 24 to 126 months. Results. The infection was eradicated in 29 patients before the fixator removal. Excellent bone healing was found in 12, and excellent functional result in 5 out of 30 patients. There was a total of 87 complications in 30 patients. Conclusion. Ilizarov technique is a method of choice in saving the limb with chronic osteomyelitis and infected pseudo- arthrosis. Because of the additional injuries, bone healing in affected limb may be superior to the functional result. Key words: external fixators; femoral fractures; femur; fracture fixation; fractures, ununited; Ilizarov technique; osteogenesis, distraction; osteomyelitis; pseudoarthrosis; war In 1951, G.A. Ilizarov and his colleagues (1) in the Siberian city Kurgan developed the method of dis- traction osteogenesis for treating acute trauma frac- tures. Over the years, the method proved to be so widely applicable and effective that the Association for the Study and Application of the Methods of Ilizarov (ASAMI) was established in Lecco, Italy, in 1982 (2). Further development of the method and de- vices has extended its indications in the treatment of trauma fractures and their complications, especially to chronic osteomyelitis accompanied by the bone loss, infected nonunion, shortening of extremities, ax- ial deformation, and joint contracture (1-3). Patients with such diagnoses have usually been treated by a series of different surgical treatments, including sequestrectomies, drainage, and massive cancellous bone grafts. These techniques are often unsuccessful (4) because the infection is difficult to eradicate due to poor vascularization of the bone. In additon, the grafts introduce a foreign body, and the resistant bac- teria may develop as the result of a long-term antibi- otic administration (5-7). Such patients are the candi- dates for treatment by the Ilizarov method. Ilizarov method consists of extensive removal of all infected tissues, application of an external fixator, and correction through distraction osteogenesis, de- angulation, and compression (3,8,9). The most im- portant element of the Ilizarov treatment is distraction osteogenesis, which involves bone transport and the formation of new bone by intramembranous ossifica- tion (9). Distinct advantage of the Ilizarov treatment is active use of the affected limb to improve its physio- logical function, which consequently minimizes the development of disuse osteoporosis and atrophy of soft tissues. Despite all these advantages, the reports on the use of Ilizarov technique after nonunion and osteomyelitis of femoral fractures are scarce (10,11). We present the results of the treatment by Ilizarov method in 30 patients with chronic fistulous osteomyelitis and infected pseudoarthroses of the fe- mur. The follow-up period was 2-10 years. Patients and Methods Between 1989 and 1999, 30 patients (24 men and 6 women) of the average age of 39.4±14.4 years (range, 25-80 years) were treated by one of the Ilizarov techniques – the distrac- tion osteogenesis – at the Department of Orthopedics, Holy Ghost General Hospital, Zagreb, Croatia. Status of Patients before Ilizarov Treatment Thirty patients with either infected femoral nonunion (23 patients) or chronic fistulous osteomyelitis (6 patients) and a pa- tient with active infection of soft tissues (Table 1) were considered eligible for the treatment with the Ilizarov method. All had al- ready undergone a long and unsuccessful treatment in other hos- pitals. Twenty-eight patients had been transferred from other hos- pitals for limb salvage and two patients were treated by other techniques at our Department. Infected non-union or osteomyelitis developed in four pa- tients after an open fracture, in 12 patients after a closed fracture, and in 14 patients with war wounds (Table 1). In all patients, the fractures of the femur were either diaphy- seal or metaphyseal, and in 17 patients were multifragmentary. For the treatment of original fractures, the patients had undergone 4.4±3.6 surgical procedures on average (range, 1-17) before the 634 www.cmj.hr