Ilizarov treatment of pilon fractures is it mandatory to internally fix the fibula?

Open reduction and internal fixation [ORIF] of the fibula in conjunction with external fixation of Pilon fractures is controversial. The aim of this study was to evaluate the results of treatment of Pilon fractures using spanning llizarov external fixator with or without internal fixation of the tibial articular surface, without open reduction and internal fixation of the fibula. This study included 15 Pilon fractures in 14 patients. Eight fractures were open, and seven were closed with different degrees of skin contusions, abrasions, blisters, and gangrenous skin patches. Ten fractures [66.7%] were AO/OTA type C3, two were type C2, two were type C1, and one fracture was type B3. All patients were treated using Ilizarov spanning external fixator without ORIF of the fibula. Open reduction and minimal internal fixation of a medial malleolar fragment was done in 5 fractures [33.3%]. One fracture [6.7%] required open reduction of a severely displaced anterolateral tibial fragment through an anterolateral approach, Bone graft was needed in one fracture [6.7%].All fractures united. The mean clinical ankle score at the final follow up was 74.2 +/- 16.18. Some degrees of malunion occurred in 9 ankles [60%]. Osteoarthritis occurred in 3 ankles [20%]. These results are comparable to published series in which the fibula was internally fixed. ORIF of the fibula is not mandatory in the treatment of Pilon fractures using llizarov spanning external fixator

Treatment of severe juxta-articular deformities using Ilizarov technique

Proper alignment of the mechanical axis and joint orientation lines in juxta-articular deformities requires a combination of angulation and translation of a metaphyseal osteotomy. In severe deformities, the translation required decreases bone contact at the osteotomy site to a great extent. In addition, this translation may cause a bony prominence and a bad cosmetic effect. This study was carried out to evaluate the results of treatment of severe juxta articular deformities using an Ilizarov external fixator with hinges at the center of rotation of angulation of the deformity to produce angulation and translation at a metaphyseal osteotomy to correct the mechanical axis. In addition we aimed at assessment of the effect of bone displacement on the cosmetic appearance of the patients. The material of this work consisted of 14 severe juxta- articular lower limb deformities that were treated using llizarov technique and a metaphyseal angulation displacement osteotomy. Ten cases had unilateral deformities and two cases had bilateral deformities. The study included 9 males and 3 females. Their age ranged from 11 to 35 years [mean: 19.75 +/- 8.37]. The mean preoperative deformity was 30 +/- 7.81. The mean preoperative limb length discrepancy in unilateral cases was 4.3 +/- 2.2 cm. All osteotomies healed. The mean external fixation time was 22 +/- 9 weeks. All deformities were successfully corrected to within the normal range except one patient who had 10 mm of lateral mechanical axis deviation after treatment for a varus deformity with 10 cm of limb length discrepancy. The amount of lengthening ranged from 2 to 8 cm [mean: 3.37 +/- 2]. All patients were satisfied with the cosmetic appearance after correction of their deformities. Severe juxta-articular deformities can be corrected most accurately with metaphyseal angulation displacement osteotomy using Ilizarov external fixator

Treatment of residual stage of chronic haematogenous osteomyelitis using distraction histogenesis

Patients in the residual stage of chronic haematogenous osteomyelitis suffer from limb shortening, skeletal deformities, or joint contractures. Treatment of these patients may carry the risk of reactivation of infection or nonunion of an osteotomy. This study was carried out to assess the healing index and complications of Ilizarov distraction histogenesis for treatment of late sequalae of chronic haematogenous osteomyelitis in the residual stage. The present study included 10 patients. Their age ranged from 8 to 35 years [mean: 19.4 +/- 9.3]. Five patients were treated by lengthening only, 3 patients were treated by deformity correction and lengthening, one patient was treated by pelvic support osteotomy and lengthening, and one patient was treated by compression of nonunion and lengthening through a separate osteotomy. The lengthening achieved ranged from 3 to 19 cm [mean: 6.5 +/- 4.8]. The total duration of fixation ranged from 16 to 64 weeks [mean: 32.7 +/- 16.2]. The lengthening index ranged from 0.87 to 1.75 months / cm [mean: 1.42 +/- 1.35]. One patient developed 10° of fixed flexion deformity of the knee and 10° of ankle equinus deformity after 8 cm of tibial lengthening and varus deformity correction. He also had 10 mm of lateral mechanical axis deviation. Another patient had 18° of residual femoral varus deformity following 19 cm of femoral and tibial lengthening. There were no nonunions, no dislocations, or neurovascular injuries. llizarov distraction histogenesis is a safe and reliable method of treatment of late sequalae of chronic haematogenous osteomyelitis in the residual stage

Treatment of neglected dislocations and fracture dislocations of the elbow using a hinged external fixator

Neglected dislocations and fracture dislocations are rare, but they are occasionally set developing countries. Treatment options include open reduction, excisional arthroplasty, arthrodesis, and hinged external fixators. This study was carried out to assess the results of treatment of neglected elbow dislocation: fracture dislocations using open reduction and early active motion in a hinged external fixator. The material of this work consisted of seven patients of neglected elbow dislocations fracture dislocations. 5 cases [71.4%] were not associated with fractures and two cases [28.6%] were associated with fracture of the radial head. Three cases [42.9%] had in addition a significant bar of heterotopic ossification. All patients were treated by open reduction, excision of the loose fragments of the radial head when present excision of the heterotopic bone when present, and a hinged external fixator. Ilizarov external fixator was used in 5 cases [71.4%] and a monolateral [orthofix] fixator was used in the remaining two cases [28.6%]. The Mayo elbow performance score was used to evaluate the results. The mean score at the end of follow up ranged from 70 to 95 points out of 100 points [mean: 85 points +/- 9.57]. Three cases [42.9%] were considered excellent, three [42.9%] were good, and one [14.3%] was fair. The range of movements at the end of follow up ranged from 60 to 120 degrees [mean: 90 +/- 23.09]. The improvement of the range of movements was statistically significant. Open reduction and early active motion in a hinged external fixator provides an excellent option of treatment for neglected elbow dislocations and fracture dislocations. It restores congruent joint reduction, stability, and functional range of movements

Osteoporosis of the Hip in pregnancy and lactation

Osteoporosis of pregnancy and lactation has been described as an uncommon transient and self-limited condition of uncertain aetiology and prognosis. The duration of the signs and symptoms was described to be one to 45 months.mostly 3-12 months. All signs and symptoms are non -specific and non pathognomonic. Diagnosis necessitates awareness for detection and the exclusion of many clinical conditions both intra- and extra-articular. Similar changes were described in males, children and pregnant females in different joints, bones and the spine; this fact adds to the difficulty in diagnosis and understanding of the underlying mechanisms. Many methods of treatment were described and many authors believe that none of the treatment regimens seem to alter the course of the disease. In the present report, thirteen pregnant and/or lactating women were diagnosed, treated and followed -up for 6-7 years after the last delivery. Eight women were treated with Salmon Calcitonin. The results were significantly better than those treated by bed rest and analgesics only. Recurrences were encountered in 15.4% of the patients. High index of suspicion is needed for diagnosis of this condition and calcition may be of some help in its treatment

Arthroscopic repair of isolated triangular fibrocartilage complex tears

A prospective study included 22 patients with a symptomatic triangular A. JL Jibrocartilage tear [Palmer's type IB or type 1C]. Pre-operative clinical diagnosis was confirmed by conventional MRI, MRI arthrogram and arthroscopically. All cases were arthroscopically repaired using the two needle technique. The mean follow-up period was 26 [range, 11 to 48] months. Pre-operatively, all patients complained of pain, restricted wrist and forearm motion and weakness of hand grip. According to the used El-Hadra wrist function scoring system, the mean pre-operative score was 9 [range, 4 to 12] points that improved after surgery to a mean of 20 [range, 16 to24] points, with thirteen wrists were graded excellent, eight good and one as fair. Pain was relieved completely in 15 wrists. Eighteen patients gradually returned to their original jobs and sports activities. The mean objective range of wrist movements increased to 91% of that of the normal side and the mean grip strength improved to 83% of the unaffected side. The results are encouraging and the procedure would seem to be an effective treatment for Palmer's types IB and 1C TFCC tears. It is also a less invasive option of management that may have mechanical advantages of stabilizing the ulnocarpal articulation and the distal radioulnar joint, while significantly improving the clinical symptoms