Treatment of infected nonunion tibia by ilizarov external fixator

Nonunion of the tibia associated with infection have always been a challenge to orthopedic surgeons. The ideal treatment should be comprehensive with the ability to simultaneously tackle axial deviations shortening, bone loss, poor local vascularity and achieve bony union without further compromising the soft tissue envelope. All of the above should be achieved by using Ilizarov external fixator in treatment of infected nonunion tibia by compression distraction technique. From 2005 to 2007; 25 patients with infected nonunion tibia were treated by Ilizarov external fixator. Of 25 infected nonunion tibia, 18 were diaphyseal, 7 were metaphyseal, 22 after open fractures and 3 after closed fractures, 5 nonunion with quiescent infection with no drainage, and 20 active infection with drainage, with infection developed after internal fixation in 15 cases, after external fixator in 7 cases and after casting in 3 cases. The mean duration of treatment was 12 months. The duration of follow up ranged 12 to 38 months [mean 22 months]. The mean time of union were 9 months [range 4-11 months]. Bone deformity was corrected in all patients except in 2 with residual deformity less than 5 degrees. The bone result was excellent in 18 cases, good in 6 cases, and fair in 1 case. The functional results were excellent in 15 cases, good in 5 cases, and fair in 5 cases

Management of postburn stiff elbow

The activities of daily living using the elbow joint are possible with a functional arc of 100 degrees . Loss of motion of the elbow joint sufficient to produce moderate to severe functional impairment in activity of daily living or occupational and recreational activities is common after various elbow insults. Following burns it is not uncommon to have stiffness of the elbow due to heterotopic bone formation and ankylosis. To evaluate the efficacy of using surgical techniques, continuous passive motion [CPM] and intermittent passive and active assisted exercises in increasing the range of motion of the elbow joint after postburn stiffness. Between April 2001 and January 2005 twelve elbows of postburn stiff elbow in ten patients were surgically treated in Assuit burn center with an average age of thirty-two years; female to male ratio [9 to 1]; two cases were bilateral; humero-ulnar bony ankylosis was found in eight elbows while the other four elbows had a preserved minimal range of motion. Excisional arthroplasty was done in eight elbows while soft tissue procedures were done in the other four elbows . CPM and different types of exercises were used to regain the range of motion. All patients were evaluated with an average follow up of 22 months, with revision surgery done in two cases. The average range of gained flexion was 70 degrees [ranged 35-110 degrees]. All patients were satisfied with the gained functioning painless range of flexion at the end of the follow up. The use of surgical procedures in combination with [CPM] and intermittent passive and active assisted exercises has been found to be an effective procedure to regain functioning painless range of flexion after postburn stiffness of the elbow