ABSTRACT
OBJECTIVE: To observe the results of chondrodiastasis / physeal distraction in the management of pseudarthrosis of tibia by Ilizarov ring fixator
PATIENTS AND METHODS: Nine patients, seven males and two females, with congenital pseudarthrosis of tibia were treated from February2008 to April 2012. The age at the onset of Ilizarov treatment was 10 to 12 years. Meticulous and complete resection of the sclerotic bone ends and surrounding fibrous hamartoma, and reopening of the medullary canals was done. Two navigation wires were passed through both the malleoli. Generous autogenous bone graft was placed, harvested from the ipsilateral iliac crest. Advanced hybrid Ilizarov ring fixator was applied. Acute compression at the pseudarthrosis site was done. One ring was applied in the proximal tibial epiphysis. Fracture was done at proximal physeal plate by rotatory movements. Fibula attached proximally and distally to proximal and distal rings. Distraction was started on the 5th day at the rate of 0.5 mm/24 hours for 10 days. Later on distraction rate was accelerated to 1mm/day with a rhythm of 0.25 mm/6 hourly. Ankle deformities were addressed accordingly
RESULTS: Union was achieved in all the nine cases at the time of frame removal. All the other associated deformities were addressed simultaneously while the frame was on. Leg length discrepancy was addressed by physeal distraction. Growth was not arrested in all cases after physeal distraction
CONCLUSION: Ilizarov ring fixator remains the treatment of choice to achieve refracture free union till 4 years in congenital pseudarthrosis of tibia, one of the most perplexing and challenging orthopedic problems. And there is no physeal arrest after physeal distraction to treat leg length discrepancy
ABSTRACT
This prospective study, carried out in the Dept. of Orthopaedics at Civil Hospital Karachi, describes the results of our new technique i.e. the window procedure in the surgical management of Congenital Talipes Equino Varus [CTEV] of the mild and moderate type [Dimeglio Classification]. One hundred and thirty six patients, aged 6-18 months, were included in the study. Amongst them were 90[66%] boys and 46 [34%] girls. Out of the 136 patients treated with this new procedure, 15 were excluded from the study. Amongst the remaining 121 cases, 109 [90.08%] were functionally good. Nine [7.44%] patients had fair results and needed manipulation under general anaesthesia, while three [2.48%] were functionally poor. Amongst them two needed revision of Achilles tendon`s tenotomy while one needed revision surgery i.e. extended posterio-medial release. In view of good results and fewer complications, we advocate the use of this newer technique for CTEV of the mild to moderate type
ABSTRACT
This series includes 180 patients of Chronic Osteomyelitis who were treated with antibiotic beads from September 1995 to October 2001 in the Dept. of Orthopaedics at Civil Hospital, Karachi. Amongst them were 126 [70%] males and 54 [30%] females, with an age range of 12-52 years. They were followed -up for a minimum period of three years. One hundred and fifty three [85%] cases recovered fully with good functional result. In 18 [10%] patients the result of the treatment was fair as the patient ultimately recovered after initial problems, while in nine [5%] it was poor as the patients had to undergo another surgery. In view of good functional results, and fewer recurrences and complications, we advocate the use of antibiotic beads in the treatment of chronic osteomyelitis of long bones