A child has a tibial non-union with a 5 cm bone gap, an infected medullary cavity (history of osteomyelitis), and 3 cm of limb length discrepancy. The most appropriate Ilizarov technique in this complex scenario is:

• A Acute shortening of 5 cm at the non-union site, then no lengthening
• B Intramedullary nailing with auto-bone graft after infection control
• C Vascularized fibular graft with simultaneous lengthening via a separate corticotomy
• D Acute shortening with primary bone contact and gradual re-lengthening (bone transport or bifocal technique) ✓

Explanation

In infected tibial non-union with bone gap and limb length discrepancy, the Ilizarov technique of bone transport (bifocal osteosynthesis) is ideal: a proximal (or distal) corticotomy creates a transport segment that is gradually translated through the infected/defect zone while simultaneously lengthening the limb. This eradicates dead space by biologically replacing it with vascularized regenerate bone, addressing infection, bone gap, and LLD simultaneously. Acute shortening alone leaves a limb length discrepancy. Intramedullary nailing in an infected bone risks implant colonization and catastrophic failure. Vascularized fibular graft is an alternative but Ilizarov transport is preferred when infection is present.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.