International Orthopaedics

, Volume 42, Issue 12, pp 2933–2939 | Cite as

Clinical outcomes with the corticotomy-first technique associated with the Ilizarov method for the management of the septic long bones non-union

  • Gamal Ahmed Hosny
  • Abdel-Salam Abdel-Aleem AhmedEmail author
  • Mohamed Abd-Elaal Hussein
Original Paper



Corticotomy is an integral part of the Ilizarov method on management of infected nonunited fractures that are challenging orthopaedic surgeons. However, the presence of active draining sinuses may contaminate the operative field with the potential of developing corticotomy site infection. The authors present a surgical technique aiming at minimizing or avoiding the risk of surgical site infection (SSI) in the corticotomy zone.

Patients and methods

A total of 144 cases of draining infected nonunions were treated by Ilizarov fixator using the corticotomy-first technique. The study included humeral (18 cases), femoral (52 cases), and tibial (74 cases) nonunions. The mean age was 44.48 years with 87 males and 57 females. The mean duration of nonunion was 28.69 months. After debridement, the combined shortening and nonunion gap averaged 5.98 (range 3–10) cm. Evaluation of bone and functional results was done according to Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria.


The follow-up period averaged 51.05 (range 36–72) months. None of the cases developed corticotomy site or distraction gap infection. Union was successfully achieved in 141 cases (97.92%). Nonunion persisted in three cases (2.08%) in the distal tibia. Infection was eventually controlled in 138 cases (95.83%). Bone grafting was not needed in any case.


The Ilizarov fixator with the corticotomy-first technique was effective in the management of draining infected non-united fractures of long bones while avoiding the SSI in the corticotomy site in all cases.


Surgical site infection Infected nonunion Corticotomy External fixator Ilizarov Infection 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Gamal Ahmed Hosny
    • 1
  • Abdel-Salam Abdel-Aleem Ahmed
    • 1
    Email author
  • Mohamed Abd-Elaal Hussein
    • 2
  1. 1.Orthopaedic Surgery Department, Faculty of MedicineBenha UniversityBenhaEgypt
  2. 2.National Institute of Neuromotor SystemEl-Tahrir CityEgypt

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