Correction of complex foot deformities by ilizarov external fixator

Complex foot deformity is defined as foot with multiplanar deformities with or without shortening. It can be corrected either by the conventional techniques with some complications or by Ilizariv external fixator which enables correction in all three orthogonal planes at a rate of which may be tailored to the type and degree of the deformity. 13 feet in 12 patients suffering from complex foot deformities were treated by Ilizarov method. The etiologic factors were burn contractures [one foot], poliomyelitis [three feet], one of which with leg-length discrepancy, neglected and relapsed club feet [7 feet], trauma [two feet] and leg-length discrepancy. These patients were 9 males and 4 females, average age of these patients was 16 [10-40] years the duration of fixator application was 6 [3-15] months. Corrections without an osteotomy in five feet were performed and with osteotomy in eight feet. Additional bony corrective procedure included one tibial osteomtomy in only case of leg-length discrepancy for lengthening and deformity correction and one tibiotalar arthrodesis. Types of deformity were Pesequinovarus [8 feet], equinus [3 feet] and Pesplanovalgus [2 feet]. The evaluation of the results depended on [degree of correction, improvement of walking and opinion of patients or patient's parents] so there were 9 excellent [69.2%], 2 good [15.4%] and 2 poor [15.4%]. The follow-up period was 28 [12-40] months. The Ilizarov external fixator for correction of complex foot deformity is successful and advantageous method but to some extent is difficult and lengthy

Operative treatment of irreducible type III supracondylar fracture of the humerus in children by open reduction and internal fixation

Fifty children who had sustained Gartland type III supracondylar fractures of the humerus failed to be satisfactory reduced closely. Once in 40 patients, twice in 8 and thrice in 2 were subjected to open reduction and internal fixation through the posterior bilaterotricipital approach. These patients were 37 boys and 13 girls with average age 6.5 years. The results were analysed by Flyn's supracondylar rating scale both functionally and cosmetically. The overall functional results were excellent in 25 [50%], good in 15 [30%], fair in 8 [16%] and poor in 2 [4%] patients and for the overall cosmetic results, excellent results were in 47 [94%] and good in 3 [6%], Forty-eight patients of this study had full extension range after surgery. The final results were found affected by the times of closed reduction as well as the time delay of operative intervention. We found open reduction and internal fixation for supracondylar fractures in children by bilaterotricipital approach is a safe and effective procedure with no cosmetic poor results and little functional restrictions

Treatment of tibial and femoral infected non union by the Ilizarov technique

Experience in 33 cases: all were done in our Orthopedic Department, Zagazig University Hospital.Ilizarov circular external fixator creating internal bone transport or compression distraction techniques were used to treat 33 patients with infected non unions or segmental bone loss. There were 20 tibial and 13 femoral. Their mean age was 38 [11-60] years and there were 25 men and 8 women. 25 patients had active infection with drainage and 8 were previously infected. After resection of the infected and necrotic bone, the intercalate defect averaged 5 [3-10] cm. The mean duration of treatment was 11 [4-18 months]. Regeneration of the distraction gap was achieved in all 33 patients. Union at the target zone was achieved in 29 and in the remaining four cases consolidation were achieved after application of autogenous bone grafts. The infection was eradicated in all cases.Complications were not severe and did not affect the final results. Residual malalignment remained in three patients, two femoral with 10° and 8° varus deformity and one tibial with 11° valgus deformity. The final leg-length discrepancy never exceed one cm. Residual fixed flexion deformity of the knee was left in two cases, but only ranges from 5° - 10° and loss of ankle dorsiflexion in three patients. There were no intraoperative or postoperative neurovascular damage or compartment syndrome.Psychological intolerance was seen in one young patient and delayed union in four cases. Almost patients returned to their previous occupation. So, we may prove also that radical debridment and bone transport is a simple and safe method for successful treatment of infected non union