Bone transport for segmental skeletal defects of the forearm bones

In this study, the results of the use of Ilizarov method of bone transport to overcome the bone defect of forearm bones were reported. The study included 16 patients with bone defect of forearm bones either posttraumatic or following debridement of osteomylitis or infected nonunion. The mean time from injury to the Ilizarov procedure was 11.7 months. The mean operative procedures before the application of the Ilizarov device was 3.4. The mean length of the defects after debridement was 6.4 cm. The Ilizarov circular external-fixator construct was used. Mono-focal osteotomy was performed. Distraction begun approximately at seven days after the operation at 0.25 mm four times daily. The results were evaluated clinically using the external fixation index, the distraction index and the maturation index. The roentgenographic quality of the regenerated bone was evaluated with the criteria of Catagni [1998]. The mean external fixation index, distraction index and maturation index were 41.5 days/cm, 19.8 days/cm and 21.7 days/cm, respectively. The mean time in the frame was 8.9 months. The mean total duration of treatment including the fixator and cast duration was 11.4 months. There were 14 complications in 11 patients including pin track infection, premature consolidation, delayed union at the docking site and refracture. There were varying degrees of limitation of pronation and supination in all patients

Ilizarov technique as a salvage procedure in treatment of congenital pseudarthrosis of the Tibia

The study included six patients with dysplastic congenital pseudarthrosis of the tibia treated consecutively by Ilizarov technique as a salvage procedure after previously failed other surgical techniques. Two patients had associated neurofibromatosis. The average age was five years [range 2-10]. At an average follow up of 24 months [range 12-36 months], all cases of congenital pseudarthrosis of the tibia had healed [100% union] and simultaneous correction of deformity and shortening was achieved. The mean time for union was four months. The leg length discrepancy was corrected from an average of 4 cm preoperatively to an average of 0.5 cm after removal of the fixator. There were two minor complications of the Ilizarov fixator, which were treated conservatively and did not affect the outcome. The results showed that Ilizarov technique can be considered as a good option as a salvage procedure in treatment of congenital pseudarthrosis of the tibia with excellent results, avoiding amputation and achieving a well functioning limb

Treatment of nonunion of the humerus using the Ilizarov external fixator

Sixteen patients with nonunited humeral shaft fractures were treated from January 1999 to December 2001 using the Ilizarov method of monofocal compression. 14 were males and 2 were females, their ages ranged between 22 and 55 years with a mean age of 34. All of them had at least one previous surgery, 8 cases had plate fixation, 4 cases were treated with external fixator and the other 4 cases had intramedullary fixation. Seven nonunions were hypertrophic, and 9 were atrophic. Seven cases were infected nonunion. The combined circular-semicircular modification from Cattaneo et al was used with wires and 5 mm unilateral self tapping Shanz pins. The average follow-up period was 12 months. Union was obtained in 15 cases with an average consolidation time of 4 months. Apart from superficial pin tract infection seen in most of the cases, there was no nerve injuries or other significant complications. The results show that Ilizarov method is a reliable method for the treatment of humeral nonunion, even after multiple previous surgeries or in the event of infection

Conservative versus surgical treatment in management of salter-harris type II distal tibial physeal fractures

Twenty-one patients with Salter-Harris type II physeal fractures of the ankle were treated, either conservatively or operatively, according to the indication for the different types of mechanism of injury. All patients were evaluated and followed clinically and radiologically for an average of 15 months. There were 15 males and 6 females. The average age at injury was 9 years and 6 months, whereas the average age at follow-up was11 years. Thirteen patients were treated conservatively by closed reduction, while eight were treated operatively by open reduction and internal fixation. There were no nonunion or arthritis. There was one case of clinically insignificant premature physeal closure. The overall results were good or excellent in 100% of cases and excellent in 86% of cases. There was significant relation between mechanism of injury type and line of treatment. We think that closed reduction should be attempted in every case of Salter-Harris type II physeal fractures of distal tibia with good results, and operative treatment with open reduction and internal fixation could be reserved to cases of irreducible or incompletely reduced fractures, and we found that most of the cases of distal tibial physeal fractures of pronation-eversion external rotation, injury type, needs surgical management

Treatment of aneurysmal bone cysts in childhood period

15 cases of Aneurysmal Bone Cysts [ABCs] were treated in Mansoura University Hospital [Oncology unit] and Sohag University Hospital from 1996 to 1999 with subtotal resection and transplant fibular and iliac graft from the mother. All cases were type II according to Capanna's classification. There were 9 boys and 6 girls. The site of the lesion was in mletadiaphysis area. The distribution of the lesion were 6 cases in the upper third of the tibia, 5 cases in the upper third of the humerus and 4 cases in the upper third of the femur. All cases immobilized in the plaster cast for 3 months. The follow up period ranged from 6 month to 3 years [average 2 years]. The results were evaluated clinically, radiologically and functionally. There was no recurrence and complete healing in 87% of cases and 13% of cases has incomplete healing but there is no recurrence. The overall end results were excellent in 80% of cases, 13% of cases has good result and 7% of cases has fair result. Subtotal resection and allograft from the mother is a good alternative in the treatment of the huge aggressive ABCs in which the subtotal resection prevent the recurrence and allograft from the mother to fill the defect in the child