DOI: https://doi.org/10.36347/sjams.2026.v14i04.001

Pages: 428-432

Background: Chronic osteomyelitis of the tibia often results in limb shortening, leading to gait impairment, functional limitation, and decreased quality of life. The Ilizarov technique, utilizing distraction osteogenesis, allows simultaneous limb lengthening and infection management. Corticotomy can be performed primarily or secondarily, but comparative data on functional outcomes are limited. Objective: To compare the efficacy, safety, and functional outcomes of primary versus secondary corticotomy of the proximal tibia in patients with limb shortening due to chronic osteomyelitis. Methods: This comparative study included 58 patients treated from 2020 to 2024 at a tertiary care hospital in Khulna, Bangladesh, divided equally into primary (n=28) and secondary (n=28) corticotomy groups. Patients underwent preoperative infection control, debridement, and Ilizarov external fixation. In the primary group, corticotomy was performed immediately after debridement; in the secondary group, corticotomy was delayed until infection control and soft tissue stabilization. Limb lengthening, bone union, complications, and functional outcomes were assessed, with ASAMI criteria used for functional evaluation. Results: The majority of patients were male (primary: 89%, secondary: 93%), with motor vehicle accidents being the most common cause of injury. Average limb lengthening was 4.4 cm in both groups. Union was achieved in 24 patients (86%) in the primary group and 26 patients (93%) in the secondary group. Median recovery time was shorter in the primary group (18 months vs. 24 months), with more surgical interventions (5 vs. 3). Functional outcomes were superior in the secondary group, with an overall good-to-excellent ASAMI rate of 90% compared to 72% in the primary group. Complications were comparable, tibial shortening, pin tract infection, non-union more common in primary group Below knee amputation occured only in primary group (1 case). Conclusion: Both primary and secondary c