Distraction osteogenesis in the treatment of stiff hypertrophic nonunions using the Ilizarov apparatus.

The principle of treating stiff hypertrophic nonunions of long bones with distraction using the Ilizarov method permits simultaneous correction of axial deformity, angular deformity, translational deformity, shortening, and, in most instances, infection. Twenty-one hypertrophic nonunions in 19 patients were treated using the Ilizarov apparatus in distraction. Six of these patients had associated chronic osteomyelitis. Ilizarov treatment ranged from four to 12 months (mean, 6.5 months). Follow-up time ranged from three to 11 years. Stable union was achieved in all patients. Angular, axial, and translational deformities were corrected in all patients; length discrepancies were corrected in 18 of 21 patients (86%). Infection resolved in five of the six cases (83%) with chronic osteomyelitis. The sole complication was axial collapse of regenerate bone (in one patient with subsequent loss of 2 cm of lengthening) after premature removal of the Ilizarov fixator. Distraction osteogenesis in the treatment of stiff hypertrophic nonunions offers the most complete method of providing optimal limb function. The process allows the patient to maintain extremity mobility and weight bearing while undergoing treatment.