Résumé
Treatment of infected forearm nonunion and defects represents a difficult task for the operating surgeons. Conventional methods like composite and vascularized fibular grafts and the induced membranes filled with cancellous autografts or the Masquelet technique have been reported to be useful and successful, but sometimes it is difficult to predict the outcome and cannot address simultaneous deformities or the need to apply gradual distraction for reduction of a chronically dislocated radial head. Ilizarov technique has an answer for such conditions. We report a 43 years old man with infected ulnar defect and dislocated radial head as a result of infected Monteggia fracture: the patient was successfully treated by Ilizarov bone transport after failed attempts by bone spacer and fibular graft.
Résumé
Abstracts: Exploitation of the regenerative capacity of bone has spawned a diverse spectrum of modalities to correct osseous defects. Distraction osteogenesisis a process of new bone formation betweenthe surfaces of bone segments gradually separatedby incremental traction. Surgical methods of distraction osteogenesis represent a reliable biologic approach to correct difficult congenital, post-traumatic, or other acquired skeletal deformities. Distraction osteogenesis can be used to lengthen the ramus and the body of the mandible, as well as for ridge augmentation. It can also protract the maxilla or if necessary the entire mid-facial complex in cases of severe deformity.Distraction osteogenesis provides a viable alternate for the correction of transverse deficiencies through true skeletal mandibular widening providing a new paradigm for patients whose treatment alternative and results were previously limited.
Résumé
[Objective]To explore the apparatus assembly,operative methods,post-operative management procedure and the effect of Ilizarov's technique of distraction histogenesis to correct the severe compound knee joint deformities (more than two deformities of knee joint such as knee flexion contracture with genu varus and limb shortening).[Method]According to Ilizarov technique of distraction histogenesis,three dimensional knee joint distraction apparatus together with limb lengthening accessories for simultaneous lengthening of the lower limb were designed.In accordance with different types of compound knee joint deformities and the positions of skeletal deformities,across knee joint distraction apparatus was applied with simultaneous distal femoral or proximal tibial osteotomy.Soft tissue contracture of knee joint along with co-existing skeletal deformity and shortening were simultaneously corrected by slowly turning the corresponding distraction rods at seven days after the operation.During the period of distraction,patients can walk with partial weight bearing.After healing of the distraction bone regenerate,the distraction apparatus was removed and the knee joint brace applied for the patients to walk for about 3～6 months.From May 1996 to Feb 2004,compound knee joint deformities were corrected in 14 patients aged between 5 and 41 years old with an average age of 27 years and etiologies of 7 kinds,in whom four cases had developmental deformities of the knee joint caused by epiphyseal injury or infection in infancy and ten cases caused by other reasons.[Result]The time of joint distracting and bone healing was 80~390 d,average 154 d.All cases had satisfactory correction of severe compound knee joint deformities such as knee flexion contracture,genu varus,genu valgus,limb shortening and rotational deformity with good walking function.None had complications such as severe pin tract infection,injury to blood vessels and nerves and non-union.But a different extent of knee joint stiffness occurred.[Conclusion]Ilizarov technique of distraction histogenesis can be used to correct severe compound knee joint deformities and limb length inequality.It follows with biological principles,makes achievements unattained by traditional orthopedic surgery and have good prospect of application.