Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects.

AIMS: Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated. PATIENTS AND METHODS: A total of 86 consecutive patients with a long tibial bone defect (≥ 8 cm), who were treated between January 2008 and January 2015, were retrospectively reviewed. A total of 45 were treated by BFT and 41 by TFT. The median age of the 45 patients in the BFT group was 43 years (interquartile range (IQR) 23 to 54). RESULTS: The size of the bone defect was significantly longer (p = 0.005), the number of previous operations was significantly higher (p < 0.001), the operating time was significantly longer (p < 0.001), and the bone transport distance was significantly increased (p = 0.017) in the TFT group. However, the external fixation time (p < 0.001), the healing index (p < 0.001), the number of additional procedures (p = 0.013), and the number of true complications (p < 0.001) were significantly reduced in this group. Both groups achieved highly satisfactory bone and functional results. CONCLUSION: TFT can significantly reduce the treatment time, the number of additional surgical procedures, and true complications compared with BFT in the treatment of long segmental tibial bone defects.

Cosmetic bilateral leg lengthening: experience of 54 cases.

The Ilizarov method for leg lengthening was used for cosmetic reasons in 54 patients with constitutional short stature. A mean lengthening of 7 cm with a low rate of complications produced an excellent or good outcome in all the patients, including improvement in psychological disturbances related to short stature. Those who undergo the procedure must be highly motivated, fully informed and understand the technique and possible complications. We suggest that the Ilizarov method for cosmetic limb lengthening is a technique without major complications. However, it requires careful follow-up, and the involvement of orthopaedic surgeons who are familiar with use of the circular frame and are experienced in limb lengthening and correction of deformity for pathological conditions.

Use of the Ilizarov technique to improve limb function following hemipelvectomy.

AIMS: Limb salvage surgery combined with tumour resection has become established in the management of pelvic tumours. However, subsequent reconstructive options for maintenance of quality of life lead to varied outcomes. We present a hitherto undescribed use of the Ilizarov technique as a second stage adjunct, for the optimisation of function, after first stage tumour resection and arthrodesis. METHODS: We describe the surgical technique used to address leg length discrepancy and abductor dysfunction following internal hemipelvectomy with ischifemoral arthrodesis. Distal femoral and distal tibial lengthening using circular frames, with a valgus subtrochanteric femoral osteotomy, enabled a rapid correction of both anomalies. Controlled varus correction at the distal femoral osteotomy site was performed to obtain a horizontal joint line at the knee. CONCLUSION: The Ilizarov technique is suitable for selected patients with tumour free survival following the initial resection. Our experience indicates that it is a good alternative to a mammoth one stage internal hemipelvectomy with reconstruction. The latter is often attempted even though there is a high risk of local recurrence and distant metastasis.

Use of the Ilizarov technique to improve limb function following hemipelvectomy. A case report.

Various surgical methods have been used for reconstruction after limb salvage surgery for pelvic tumours. We present a case of use of the Ilizarov technique as a second stage adjunct, for the improvement of function, after first stage tumour resection and arthrodesis. This technique is suitable for selected patients with tumour-free survival following the initial resection. Though not described before, our experience indicates it is an alternative to a mammoth one stage internal hemipelvectomy with reconstruction, that is often attempted even though there is a high risk of local recurrence and distant metastasis.

[Treatment of radial agenesis with the Ilizarov method]. / Traitement de l'agénésie radiale par la méthode d'Ilizarov.

PURPOSE OF THE STUDY: Typical cases of lateral longitudinal hemimelia of the upper limb are characterized by agenesia of the radius and the thumb. The hand has four fingers and due to the lack of a radius, deviates laterally beyond 90 degrees. The ulna is short in 50 to 60% of the cases. Hand function is very limited causing a major handicap in everyday life activities. We report here the long-term outcome of 14 patients treated with the Ilizarov method. MATERIAL AND METHODS: Fourteen cases in thirteen patients, mean age 14.8 years, with radial hemimelia (one bilateral surgery) were treated with the Ilizarov method between June 1981 and December 1998 at the Lecco Hospital, Italy. Currently, the circular frame is composed of 3 elements: a half ring fixed by pins and wires to the metacarpal bones, 2 rings with pins and wires in the ulna, and 2 hinge clamps between the half-ring and the first distal ring to center the hand on the ulna by applying a lateral force. After centering the hand, the procedure continues with an ulnocarpal arthrodesis and is terminated by a proximal osteotomy of the ulna for forearm lengthening. RESULTS: Patients were followed for 1 to 16 years. A last follow-up, hand function was excellent in 2 cases, good in 1, average in 10 and poor in 1. The esthetic result was excellent in 6, good in 6 and average in 2. DISCUSSION: These results demonstrate that excellent stability of the hand centered on the ulna and forearm lengthening can be achieved with the new hybrid and more stable Ilizarov circular fixation method. Surgeons should become more familiar with this new instrumentation and its use.

Hybrid advanced Ilizarov techniques: analgesia use and patient satisfaction.

Patients involved in the initial Western application of the Ilizarov technique experienced frequent pain and could not tolerate the device. With "hybrid advanced" Ilizarov techniques, half-pins and other components are added to minimize these adverse reactions. In this study of advanced techniques, we determined patient satisfaction (with end results), device tolerance, pain levels, and need for analgesia. These techniques used at least 1 half-pin on each ring--except for the distal tibial ring, which had 3 transfixing wires--perpendicular to either another half-pin or a transfixing wire. Eighty-one consecutive patients treated with advanced techniques were prospectively studied until the treatment was completed and the device removed. All patients received intravenous analgesia while hospitalized. Narcotic and non-narcotic analgesia was available to all patients, and analgesia use was measured. In addition, patient satisfaction and pain level were recorded. All patients were satisfied with end results and tolerated the device prescribed by their physician. Mean postoperative hospitalization was 5.1 days. Upon discharge from the hospital, 3 patients (3.7%) with moderate pain used postoperative narcotics for a mean of 6 days (range, 1-11 d), and 41 patients (50.6%) with mild pain used over-the-counter non-narcotic analgesia or prescription antiinflammatory medication for a mean of 4.4 days (range, 1-35 d). The other 37 patients (45.7%) were comfortable and did not require analgesia. In general, patients undergoing hybrid-advanced Ilizarov techniques infrequently needed postoperative analgesia.

Knee arthrodesis after infected total knee arthroplasty using the Ilizarov method.

Numerous treatments have been proposed for infected total knee arthroplasty. In selected patients, a knee arthrodesis is a well-recognized salvage procedure. However, there are no reports in the literature discussing the treatment of infected total knee arthroplasty using the Ilizarov method. The authors reviewed their experience with this technique in infected total knee arthroplasty, presenting six patients (four women, two men) treated between 1992 and 1998. The average age was 56.6 years (range, 23-70 years) and the mean number of previous surgical procedures was seven (range, 4-10 procedures). From the time of frame removal, the patients were followed up for a mean of 34.2 months (range, 12.4-87.5 months). Full weight-bearing was allowed 1 week after surgery if half-pins were used and after a mean of 2.6 months if Kirschner wires were used. Of the five patients who have completed treatment, all have obtained a stable knee arthrodesis after a mean external fixation time of 6.8 months without additional surgical procedures or bracing. All of the patients were satisfied with the treatment. The authors recommend knee arthrodesis by the Ilizarov method for infected total knee arthroplasty, particularly in patients with extensive bone loss, significant limb shortening or axial deformity or both, active infection, or previous failed arthrodesis.

The Ilizarov method for failed knee arthrodesis following septic TKR.

Knee arthrodesis is a well-recognized salvage procedure in patients with infected total knee arthroplasties. If a fusion is achieved, it offers the opportunity for a stable lower limb and eradication of infection, but at the expense of knee motion. However, knee arthrodesis in this setting may be difficult to achieve because of poor bone stock, persistent infection, soft tissue compromise, and often the poor general health of the patient. We report two cases of failed knee arthrodesis following periprosthetic infection where a fusion was successfully achieved with open debridement and a hybrid advanced Ilizarov fixator.

Treatment of genu varum in medial compartment osteoarthritis of the knee using the Ilizarov method.

The high tibial osteotomy has been used to treat medial compartment osteoarthritis for many years and has stood the test of time as an effective method for treatment of the varus knee in this condition. This article presents a quick, simple, safe, and effective method of doing this operation through small incisions using the Ilizarov apparatus.

Distraction osteogenesis in the treatment of stiff hypertrophic nonunions using the Ilizarov apparatus.

The principle of treating stiff hypertrophic nonunions of long bones with distraction using the Ilizarov method permits simultaneous correction of axial deformity, angular deformity, translational deformity, shortening, and, in most instances, infection. Twenty-one hypertrophic nonunions in 19 patients were treated using the Ilizarov apparatus in distraction. Six of these patients had associated chronic osteomyelitis. Ilizarov treatment ranged from four to 12 months (mean, 6.5 months). Follow-up time ranged from three to 11 years. Stable union was achieved in all patients. Angular, axial, and translational deformities were corrected in all patients; length discrepancies were corrected in 18 of 21 patients (86%). Infection resolved in five of the six cases (83%) with chronic osteomyelitis. The sole complication was axial collapse of regenerate bone (in one patient with subsequent loss of 2 cm of lengthening) after premature removal of the Ilizarov fixator. Distraction osteogenesis in the treatment of stiff hypertrophic nonunions offers the most complete method of providing optimal limb function. The process allows the patient to maintain extremity mobility and weight bearing while undergoing treatment.

Applications of the Ilizarov method in the humerus. Lengthenings and nonunions.

Between 1982 and 1992, Ilizarov's method was used in 68 lengthenings and 29 nonunions of the humerus. Special rings along with the arches similar to those used for femoral lengthening were used to allow unrestricted motion at the elbow and shoulder. These patients were followed for an average of 5.1 years. In cases of lengthening, average length achieved was 9 cm, with duration of treatment being 5 to 14 months. Overall results in most cases were excellent. In cases of nonunion, the duration of treatment averaged 226 days. Of the 29 nonunions, 25 healed. Our results, including no major complications, support the continued use of Ilizarov's technique in humeral lengthening and nonunions of the humerus.

Preliminary experience with Ilizarov method in late reconstruction of radial hemimelia.

We report the outcome of ulnar lengthening with the Ilizarov technique in five adults with radial hemimelia and previous wrist centralization. The indications for ulnar lengthening in these patients were either a functional deficit due to the short ulna or poor appearance that caused the patient significant unhappiness. All patients had a successful lengthening of the ulna, with a gain in length from 4 to 13 cm; however, the procedures were prolonged (7 to 25 months), and all patients experienced complications. At the time of follow-up examination no patient had residual pain or paresthesias. In four of five patients, although ulnar lengthening resulted in somewhat stiffer digits, it improved function of the extremity as a whole. When asked if they would repeat the lengthening, knowing what they know now, all five replied that they would. The technical difficulties encountered in these cases suggest a cautious approach to ulnar lengthening. This is a long, arduous, painful process that requires a psychologically robust patient. If the ulna is very short preoperatively, lengthening can enhance the volume of space accessible to the hand and in that way improve function.

Reuse of Ilizarov frame components: a potential cost savings?

Although there is a potential hospital cost savings in reusing Ilizarov frame components, such reuse must be carefully considered in view of the deterioration of the parts during clinical use. A study is presented that addresses this issue through examination of clinically removed frames, laboratory testing, and engineering calculations.

Management of fibular hemimelia using the Ilizarov method.

A comprehensive program for the correction of fibular hemimelia and associated deformities using the Ilizarov external fixator has been developed at the author's institution. This management involves classification of the deformity (type I, II, or III) and single or staged procedures with the goal to provide a stable plantigrade foot with correction of leg deformity and length discrepancy. The use of the Ilizarov external fixator allows correction of multiple deformities simultaneously. The initial experience with this correction with satisfactory functional and radiographic results in most patients. Final conclusions regarding treatment outcome will not be possible until a significant number of patients reach skeletal maturity.

Treatment of humeral nonunions with the Ilizarov technique.

Eighteen patients with nonunions of the humerus were treated by the Ilizarov method at the General Hospital in Lecco, Italy, between 1982-1989. This report is based upon 16 of those patients. The results are encouraging. Union was achieved in 14 patients. There were two failures: one patient had been irradiated 14 years earlier for what was thought to be plasmocytoma of the proximal humerus; the other had a humeral nonunion of the proximal third with advanced disuse osteopenia of the surrounding bone. Complications were few, and none compromised the achievement of union.

Lengthening of the humerus using the Ilizarov technique. Description of the method and report of 43 cases.

From 1982 to 1986, 43 humeral lengthenings were performed on 29 patients using the Ilizarov technique. Diagnoses included achondroplasia, old septic arthritis, birth palsy, fracture, congenital shortening, and benign neoplasm. The achondroplastic patients (14) had bilateral lengthenings. There were 16 male and 13 female patients aged ten to 36 years (mean, 18 years). The total lengthening in each segment ranged from 5 to 16 cm (mean, 9 cm) and mean treatment time from four to 14 months (mean, eight months). The average follow-up time was 2.7 years (range, 0.5-5.5 years). Functional and aesthetic results were all graded as excellent or good. There were no cases of osteomyelitis or deep infection. Three patients sustained neuropraxias that subsequently resolved completely. There were seven fractures in six patients following removal of the apparatus. Five were treated with casts and two with replication of the apparatus. All healed uneventfully. Humeral lengthening can be safely performed with excellent clinical results using the Ilizarov technique.

Lengthening of the forearm by the Ilizarov technique.

The Ilizarov technique was used for lengthening 13 forearms in 12 patients. The different types of treatment were: lengthening of the radius alone, lengthening of the ulna alone with or without radial head relocation, lengthening of one-bone forearms, lengthening of the radius and ulna to the same extent, and differential lengthening of the radius and ulna. The lengthenings ranged from 2 cm to 13 cm (10%-143%). Bone consolidation was achieved in three to 19 months without the need for bone grafting. Eleven of 12 patients were functionally and cosmetically improved. In nine patients, the cosmetic improvement made a significant psychologic difference to the patient. There were 11 complications, including three temporary deep radial nerve palsies, one sympathetic dystrophy, one malunion, one delayed malunion, two refractures, and three mild loss of motion. All of these dysfunctions were temporary, but mild stiffness persisted in three patients. The goals of treatment were achieved in all patients.