Treatment of equinus deformity with Ilizarov fixator / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the treatment of equinus deformity with Ilizarov fixator. Methods From February 2003 to August 2005, 17 patients with traumatic equinus were managed with Ilizarov fixator in our department. A preoperatively constructed ring fixator was applied on the involved foot and leg. Three days after the fixation, the compression threaded rod in the front and the distraction threaded rod at the back were respectively shortened and lengthened by turning the screw nuts on the rods 2 to 4 rounds in four times per day in the first week, and then 1 to 2 rounds in four times per day, which resulted in gradual correction of equinus deformity. The Fixation was maintained in neutral position for 2 to 3 months after achieving sufficient equinus correction to ensure the state of dorsiflexion. An ankle-foot orthosis was applied during resting and sleeping for more than three months after removal of the fixator. Results The mean follow-up period was 10 months (range, 7 to 14). All the patients achieved 0? dorsiflexion 4 to 6 weeks after the treatment while in the Ilizarov apparatus. The fixator was maintained in patients for an average of 14.5 weeks (10 to 16 weeks). No blood vessel or nerve was injured. Three patients had one mild pin track infection which responded to conventional management. A 20? equinus contracture reoccurred to one patient six weeks after the removal of the apparatus which had been maintained only for 10 weeks because the patient noted severe pain with the apparatus. One patient chose to accept his improved but persistent 10? equinus contracture. One patient who had had reconstructive surgery for his severely damaged leg muscles and tibial defect eventually required tibiotalar arthrodesis. Entire foot weight bearing with zero angle and walking without significant footdrop were achieved in the other 14 cases. Two patients complained of pain while bearing weight. Active ankle dorsiflexion of 10? beyond the neutral position was achieved in patients with functioning ankle dorsal extension muscles. Conclusion Ilizarov fixator is an effective technique to correct the equinus deformity because of its minimal invasion.