Evaluation of Treatment of Congenital Pseudarthrosis of Tibia by IlizarovMethod

Background: Congenital pseudarthrosis of the tibia, a rare but well-known disorder, has been remarkably resistant to all types of therapy designed to promote healing. Successful treatment consists of the union of the pseudarthrosis and maintenance of that union without malunion, re-fracture, or excessive shortening (<2cm) of the leg. The principle of treatment of congenital pseudarthrosis of the tibia (CPT) with the Ilizarov method corrects all angular deformities and maximizes the cross-sectional area of the pseudarthrosis. Nineteen patients with a total of 19 CPT were treated using the Ilizarov apparatus. CPT is the most perplexing challenging pediatric orthopaedic problem especially when the patient of below years of age and has a history of the previous operations and tibia narrow and osteoporotic. Therefore, the purpose of this study was to evaluate the results of treatment of CPT by the Ilizarov method. Material & Methods:The prospective study was done from July 2008 to June 2010 at the National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka. Various forces were used to treat the pseudarthrosis site including compression, distraction, open reduction, resection and shortening, resection and bone transport, and a temporary intramedullary k-wire given through calcaneum and talus into the tibial medullary cavity.Results:Lengthening was performed in all except one of the 19 patients. One patient had developed nonunion in both the pseudarthrosis site and proximal corticotomy site. The deformity was tried to correct in all cases. The union rate was 94.73% with one treatment. There were three early re-fracture. Eight patients. had a persistent residual deformity of ankle valgus from 5-9 degrees and five patients had residual angular deformity at the pseudarthrosis site from 5-10 degrees.Conclusions:One patient’s angulation degree required revision surgery, Ilizarov. All patients were given Previous sites, residual angular deformity, and natural history were considered predisposing factors for re-fracture. Two re-fractures united with months (range 10 months). This technique produced initial pseudarthrosis with the correction associated with deformity inequality. angulation and valgus.

Limb Deformity Correction Using the Ortho SUV Frame

@#BACKGROUND AND OBJECTIVE: Limb deformity in terms of length discrepancy, angular and rotational deformities are amenable to correction using the Ilizarov method. The corrections can be achieved using the Ortho SUV Frame (OSF), a computer assisted six axes external fixator. Previous studies have reported easier and more accurate deformity correction. In this study, we report on our initial experience and treatment outcomes in using this system. MATERIALS AND METHODS: This study is a case series of patients where the Ilizarov circular frame was applied and which the deformity correction was carried out using the OSF. Success and accuracy in correction, length of time to correct, number of revisions needed and complications were gathered from a review of medical records. RESULTS: Thirty limbs in twenty nine cases were included in this report. Seventy seven percent (23/30) of the deformities were due to previous trauma. The rest were due to Blounts, infection and tumor. Correction in eighty seven percent (26/30) were achieved using the turning schedule provided by the Ortho SUV application software. Three cases required surgical removal of soft tissue interposition before further correction using the software was achieved. One case with posterior translation underwent closed manipulation. In the end all planned deformity corrections were achieved. Complications included pin tract swelling and erythema in 13% and all resolved either with oral antibiotics alone or combined with surgical release of pin sites under local anesthesia. CONCLUSION: The Ortho SUV is an effective tool to carry out deformity corrections using the Ilizarov method.

"Nonunion of Adult Humerus Fracture" - Management Using the Ilizarov External Fixator.

Humeral shaft fractures occur about three percent of all fractures in adults. A very high union rate is achieved with non-operative treatment, however when nonunion occurs conservative approach or after operative management they are often very difficult to treat, and often requires multiple procedures to achieve union. Even with multiple procedures, true pseudoarthrosis have only a 59% union rate. The aim of this study was to find out the results of such complicated cases treating with Ilizarov's external fixator. We conducted a prospective study of eleven patients with nonunion humeral shaft fracture in adult wherein the outcome of the treatment was analyzed. In our series we achieved union in all of the cases with a mean of 29.1 weeks with negligible complications like pin tract infections and in one case refracture occur due to forceful manipulation. So it can be concluded that Ilizarov's method is an excellent option for the treatment of nonunion of diaphyseal fracture of the humerus.

Modified traction suture holder using an Ilizarov external fixator ring in performing a transanal endorectal pullthrough procedure

This study demonstrates the use of an innovative traction suture holder in performing transanal endorectal pullthrough procedure for Hirschsprung's disease. The device was constructed by utilizing the Ilizarov external fixator ring used by orthopedic surgeons. Used in six patients, the appliance was able to provide adequate exposure of the anal mucosa during the performance of the procedure. Operative time was shorter as compared to that of previous surgeries done without using the appliance.

Correction of Genu Recurvatum Deformity by Ilizarov Method / 대한정형외과학회잡지

Ten opening-wedge callotasis through the proximal tibia just below the tuberosity were performed using the Ilizarov apparatus in ten patients who had premature asymmetrical closure of the proximal tibial physis and subsequent genu recurvatum. In 4 knees, the genu recurvatum was due entirely to osseous deformity. In the remaining 6 knees, it was due to a combination of ossseous and soft-tissue (ligament and capsule) deformity. In the 6 knees that had combined deformity, the osseous deformity was predominant in all knees. The average age of the patients at surgery was 16.3 years (range, 11.0-20.5 years). Before operation, the average angle of recurvatum was 19.6 degree (range, 15-26 degree) with an average of 76.6 degrees of abnormal tilt of the tibial plateau. The average shortening of the ipsilateral limb in ten patients was 2.7 cm (range, 0.5-8.7 cm). The average duration of correction was 49 days (23-85 days), and the average fixation time was 150 days for management of genu recurvatum and associated limb-length discrepancy. In 3 patients, there were complications including patella infera, pin track infection and transient peroneal nerve palsy. After a mean follow-up of 4.2 years (range, 1.1-5.9 years), most patients had an excellent or good radiographic and functional results without any recurrence. We have found the Ilizarov method to be valid in the management of genu recurvatum with or without concomitant shortening, with relatively few complications, but full understanding of the basic principles and strict adherence to the details of the method must be carefully followed.

Treatment of Tibial Bone Defect by Internal Bone Transport Using Ilizarov Method / 대한정형외과학회잡지

We reviewed twenty-six tibial bone defects which had been treated by internal bone transport to evaluate the results and complications and of the Ilizarov method. The causes of defects were open fracture(13 cases) and infected non-union(13 cases) The mean bone defect was 8.2 cm, ranging from 2 cm to 20 cm, in open fracture and 6.5 cm, ranging from 2 cm to 17 cm, in infected nonunion. All cases attained bone union. The mean radiologic consolidation index was 1.3 month/cm. The mean external fixation time was 18.5 months, ranging from 4 months to 33 months. Complications were pin-tract infection(20 cases), equines contracture of ankle(4 cases), knee flexion contracture(1 case), axial deviation(5 cases), valgus deformity of ankle(1 case), leg length discrepancy(7 cases), stress fracture at corticotomy site(2 cases), delayed union(1 case), infection recurrence(1 case), soft tissue invagination(3 cases) and refracture(2 case). The Ilizarov method is a useful treatment for tibial bone defects. Bone grafting at the docking site is recommended in order to shorten the treatment time and to avoid refracture and nonunion.

Lengthening & Deformity Correction in Upper Extremities by the Ilizarov Method / 대한정형외과학회잡지

We report our series of the Ilizarov surgery for lengthening and deformity correction in upper extremity at the Severance Hospital and the Yong-Dong Severance Hospital between February 1992 and October 1994. We performed the Ilizarov surgery in 12 limb segments, there were 3 humerus, 5 radius, 3 ulna and 1 metacarpal bone. The etiologies of the limb length discrepancies were 7 posttraumatic physeal injuires, 2 congenital deformities, 1 posttraumatic bone loss, 1 posttraumatic amputation and 1 postinfectious physeal injury. The goals of treatment were bone lengthening alone in 8 cases, bone lengthening and deformity correction including angular correction in 4 cases. The bone was lengthened between 1.0 cm and 9.2 cm (mean 3.7 cm) representing a 8.1% to 63.0% (mean 24.5%) increase in length. The healing index varies from 1.0 mos/cm to 10.5 mos/cm (mean 3.4 mos/cm) except three cases which need additional fixation with plate and screws add to wedge osteotomy. By radiologic appearance of the distraction callus, the straight type were 6 cases, the attenuated type were 4 cases and the pillar type were 2 cases. The healing indices of each type were 1/5 mos/cm, 7.7 mos/cm and 12.4 mos/cm, respectively. In conclusion, lengthening and deformity correction of the upper extremity can be successfully achieved by gradual mechanical distraction using the Ilizarov method. In case of pillar type, healing index was high and therefore control of the rate and the rhythm should be tried. If this control is of no use, early interventional procedure would be beneficial. The healing index of the straight type was much lower than that of the attenuated or the pillar type.

Treatment of Gap Nonunion of the Tibia by the Ilizarov Method / 대한정형외과학회잡지

Twenty four patients with gap nonunions of the tibia were treated with the Ilizarov intercalary bone transport method. The purpose of this retrospective study is to evaluate the results and complications in gap nonunions of the tibia treated using the Ilizarov method. There were 22 males and two females with an average age of the 35.8 years(range, 23-63 years). The mean follow up period was 30.2 months(range, 17-70 months). Ten of the 24 patients had no external shortening with bone gap, 13 external shortening with gap and one hemicircumferential defect. On average, the size of bone loss measured 8.2 cm(range, 3-18 cm). Twenty-one of 24 patients were treated by whole segment internal transport(fifteen were proximal fragment transport, five were distal fragment transport, one was proximal and distal fragment transport), one patient by anterior hemicircumferential corticotomy and partial bone fragment internal transport and tow patients by fibula transfer. All patients healed with solid bony union, although twelve patients required bone grafts, eleven at the docking site and one at the distraction site. On average, the healing index was 49 days/cm(range, 18-82 days/cm). There was on relationship between the percentage transport(size of the distraction gap/the transporting fragment length x 100) and healing index. Numerous complications were encountered, most commonly delayed union and pin site infection, Conclusively, the application of Ilizarov techniques to gap nonunions of the tibia was very effective, but required correct technique and careful follow-up examination.