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Abstract Surgical reconstruction of tibial non-unions with or without associated infection can be a great challenge for the orthopaedic surgeon. These non unions are usually the result of high-energy trauma accompanied by extensive soft tissue damage at the time of initial injury. Bone defects can result from these injuries primarily or secondarily from the subsequent debridement for contamination or infection, or it may result after the debridement of devascularised or contaminated bone; prone to ischemic or septic necrosis. Bone resection may also be indicated in the treatment of atrophic or infected pseudoarthrosis and in the presence of bone tumors(1). External fixation, which is a well-accepted treatment for open fractures and damage control orthopaedics has acquired increasing importance in the treatment of bone loss in recent years. The technique proposed by Ilizarov involves the use of a circular external fixation frame with bone-gripping elements which transfix the limb(2). The debate of treating those cases is mainly between two methods, using Ilizarov as a method of fixation: acute shortening and lengthening versus bone transport mainly for looking into indications, complications, duration of treatment, another surgical intervention and requirement of bone grafting at the resected non union site.Acute shortening and lengthening technique implies repair of the bony defect by initial compression and thus shortening of the segment involved this is coupled or followedby an osteotomy in a region furthest from the defect, at which subsequent lengthening is carried out(3-4-5) Bone transport technique implies an osteotomyis performed proximal to the bone defect (ante grade transport), or distal to it (retrograde transport). Subsequently, gradual movement of the detached fragment towards the bone gap is achieved via a process which is completed when the transported segment reaches the end of the bone gap(6-7). The main indication for the two techniques is different: bone transport is indicated for the treatment of major bone loss, whereas compression-distraction is suitable only for treating less extensive bone gaps, since compression may compromise neural and vascular structures. |