Treatment of osteomyelitis and infected non-union of the femur by a modified Ilizarov technique: follow-up study.

AIM: To review the results of the management of chronic post-traumatic osteomyelitis and infected non-union with bone defects of femur using the Ilizarov technique with a modified apparatus assembly. PATIENTS AND METHODS: Thirty patients treated by the Ilizarov method because of chronic fistulous osteomyelitis and infected pseudoarthroses of the femur were included in the prospective study between 1989 and 1999. Their mean age was 39.4+/-14.4 years (range, 25-80 years). The follow-up period lasted for 24 to 126 months. RESULTS: The infection was eradicated in 29 patients before the fixator removal. Excellent bone healing was found in 12, and excellent functional result in 5 out of 30 patients. There was a total of 87 complications in 30 patients. CONCLUSION: Ilizarov technique is a method of choice in saving the limb with chronic osteomyelitis and infected pseudoarthrosis. Because of the additional injuries, bone healing in affected limb may be superior to the functional result.

Tympanometric findings in cleft palate patients: influence of age and cleft type.

Tympanometry was analysed according to cleft type with respect to age in 239 cleft palate patients (57 with bilateral cleft lip and palate (BCLP)), 122 with unilateral cleft lip and palate (UCLP) and 60 with isolated cleft palate (ICP). The frequency of type B tympanograms was 46.5 per cent in the BCLP group, 50.6 per cent in the UCLP group and 58.3 per cent in the ICP group. Type A tympanograms were more frequently observed in older patients (median age 11 years) in comparison to type B (median age five years; p < 0.001) and type C (median age six years; p < 0.001). The total sample showed an age-related decrease in the frequency of type B tympanograms (rs = -0.3942; p < 0.001). The frequency of type A tympanograms increased significantly with age (rs = 0.4263; p < 0.001), whereas type C was not correlated with age. In the UCLP group, the frequency of type B tympanograms decreased with age (rs = -0.4430; p < 0.001), the decrease being faster than in the BCLP group (rs = -0.3186; p = 0.001) and the ICP group (rs = -0.3378; p < 0.0001)). Type B tympanograms had the highest correlation with a hearing loss of 21-40 dB at mean hearing level at speech frequencies (MHLSF) (rs = 0.4574; p < 0.001), a lower correlation with a hearing loss of 11-20 dB (rs = 0.2184; p = 0.02) and the lowest correlation with hearing loss above 40 dB. At the ages of one to three, the frequency of type B is higher in UCLP patients than in the BCLP and ICP groups, decreasing at seven to 12, increasing again at 13 to 15, and thereafter showing a continuous decrease. In the BCLP group, the frequency of type B increased significantly at the ages of four to six and then decreased continuously from seven to 18. In ICP patients, the changes in the frequency of type B with age are not significant until the age of 15; at the age of seven, it is higher than in the BCLP and ICP groups. The type C tympanogram is not typically found in cleft palate patients and its frequency is not correlated with age. It can be presumed that each type of cleft lip and palate, due to its characteristic conditions in the epipharynx, will favour a different mode of pathophysiological development of middle-ear disease.

Mastoid pneumatization and aging in children with Pierre-Robin syndrome and in the cleft palate population out of syndrome.

We examined the characteristics of mastoid pneumatization in the Pierre-Robin syndrome (PRS) and non-PRS cleft palate population in relation to age. There were 14 patients with PRS (median age, 5 years), 7 patients with bilateral cleft lip-palates (BCLP: median age, 6 years), 29 patients with unilateral cleft lip-palates (UCLP: median age, 6 years) and 15 patients with isolated cleft palates (ICP: median age, 7 years). All had secretory otitis and ventilation tubes inserted. Pneumatization was assessed by standard computerized planimetric methods. Temporal bone (Schüller view) X-rays were obtained. Areas of bone pneumatization were outlined and measured separately for each ear. The median pneumatized area of the mastoid (MBP) in PRS patients (6.73 cm2) was significantly lower than in non-PRS cleft patients (7.29 cm2). It was also lower than in UCLP (7.35 cm2; P = 0.01) and ICP (7.19 cm2; P = 0.02). MBP did not change significantly with age in PRS (Spearman rs = 0.11) and BCLP (Spearman rs = 0.11), but did increase significantly in the ICP group (Spearman rs = 0.23; P = 0.04). Cubic regression showed the best fit in the BCLP (r2 = 0.61; P = 0.01) and ICP (r2 = 0.10; P = 0.05). It was not significant for PRS (r2 = 0.132) or UCLP (r2 = 0.049). We concluded that pneumatization in all cases increases with age, but it is statistically significant only in ICP. PRS patients have a lower area of mastoid air-cell size than the non-PRS cleft palate population. The extent of mastoid pneumatization in PRS patients does not correlate with age because of the negative influence of the mandibular hypoplasia and glossoptosis present.