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Abstract Objective To explore the clinical effect of bone transport using circular external fixator to treat postoperative infectious nonunion of middle and lower tibia fracture.Methods A retrospective study was conducted on 19 patients with infectious nonunion of the middle and lower tibia who were treated in our department from January 2016 to December 2018.All patients were treated with debridement，one-stage segmental osteotomy and bone transport with external fixation.Of the 19 patients，16 male and 3 female were included，with average age of (46.2±11.8)years (range：37~62 years).We recorded operative time，number of operations，healing index，duration of implantation，length of bone extension，incidence of postoperative complications，and Baird-Jackson ankle function score and HSS knee function score in each cases.Results All 19 patients were followed up.The mean postoperative follow-up was (16.9±6.8)months.The operation times was (120.6±18.6)min，ranging from 100~150 min；average operation time was (1.2±0.4)，ranging from 1~3 time；the average healing index was (39.4±8.2)d/cm，ranging from 31~52 d/cm；the average time with external fixator was (15.2±3.0)months，ranging from 12~21 months；the average length of bone transport was (7.2±2.2)cm，ranging from 4~11 cm.All patient obtained bony healing without reoccurred infection.The average Baird-Jackson ankle score was (83.4±7.1)，ranging from 72~97；average HSS knee score was (89.2±5.4)，ranging from 80~98. There were 1 case with soft tissue incarceration，and soft tissue release was conducted.1 case with shaft malformations，which was corrected after external fixator adjustment.1 case with nonunion after bone transport，which obtained bony union after internal fixation with autogenous iliac bone graft.Conclusion Infectious tibial nonunion treating with bone transport can obtain good clinical outcome.Preoperative design，intraoperative operation，and postoperative treatment，the characteristics of the bone tissue and soft tissue of the surgical site should be fully integrated to actively deal with complications.
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