Morbidity resulting from the treatment of tibial nonunion with the Ilizarov frame.

OBJECTIVE To determine the sources and magnitude of residual morbidity after successful treatment of tibial nonunion using the Ilizarov device and techniques. DESIGN A retrospective cohort study. SETTING A level 1 trauma centre. PATIENTS Sixteen patients with healed tibial nonunion. INTERVENTION Application of the Ilizarov device and techniques to obtain union of a previous ununited tibial fracture. MAIN OUTCOME MEASURES Patient satisfaction and sources of morbidity through clinical review and a visual analogue scale. Two disease-specific outcome measurement scales were used to assess ankle dysfunction. Radiographs were examined to determine the presence of arthrosis. RESULTS Residual pain was present in over 90% of patients at a mean follow-up of 39 months: in 80% the worst pain was in the ankle, less than 10% felt the worst pain in the knee or at the fracture site. Mean ankle osteoarthritis scores were 3.4 for pain and 4.0 for disability, compared with 0.76 and 0.90 respectively for age-matched controls. Mean ankle-hindfoot scores were between 64 and 100. CONCLUSION Ankle pain with disability is the major source of residual disability after successful use of the Ilizarov device for the treatment of tibial nonunion.