Management of proximal femoral fractures using the Ilizarov principles.

External fixation can be an exceptional relief solution in the treatment of proximal femoral fractures. We would like to share our experience using external fixation techniques with either the Ilizarov frame or Hofmann system in 23 patients with complicated fractures.

Distraction osteogenesis for bone repair in the 21st century: lessons learned.

Bone regeneration obtained by distraction osteogenesis is influenced by a series of factors. These include factors that are related to the mechanical stability of the system of distraction (internal or external devices), and to factors directly depending on the biology of the bone tissue, such as the method of bone interruption (osteotomy), the delay and rhythm of distraction, the anatomical site of the osteotomy, and the histological characteristics of the bone requiring reconstruction. The stability of the system of bone fixation depends on the rigidity of the frame, the connexion of the apparatus to the bone (wires, pins) and the intrinsic stability of the segment (length and level of maturation of bone regenerate). The radiological characteristics of bone regeneration (hypo- or hypertrophy) lead to the adaptation of the rhythm of distraction. Following more than 28 years of experience of application of the Ilizarov method for bone reconstruction, the authors describe the technique of frame assembly and the methods of evaluation and treatment of the complications of new bone formation.

Limb lengthening and deformity correction by the Ilizarov technique in type III fibular hemimelia: an alternative to amputation.

BACKGROUND: Fibular hemimelia is partial or total aplasia of the fibula; it represents the most frequent congenital defect of the long bones. It usually is associated with other anomalies of the tibia, femur, and foot. QUESTIONS/PURPOSES: We reviewed 32 patients with Type III fibular hemimelia treated by successive lower limb lengthening and deformity correction using the Ilizarov method. We had three aims; first, to analyze complications, including the need for reoperation. The second was to assess knee and ankle function, specifically addressing knee ROM and stability and function of the foot and ankle. The third was assessment of overall patient satisfaction. PATIENTS AND METHODS: Thirty-two patients underwent 56 tibia lengthenings and 14 ipsilateral femoral lengthenings. Their mean age and mean functional leg-length discrepancy at initial treatment were 6.7 years and 6.2 cm, respectively. Activity level, pain, patient satisfaction with function, pain, and cosmesis, complications, and residual length discrepancy were assessed at the end of treatment. RESULTS: The mean number of surgeries was six per case. The healing index was 44.9 days/cm. Although complications were observed during 60 lengthenings (82%), the highly versatile system overcame most of them. Nearly equal limb length and a plantigrade foot were achieved by 16 patients. For two patients, a Syme's amputation was performed. The outcome was considered satisfactory in 17 patients (53%) and relatively good in eight patients (25%). CONCLUSIONS: The Ilizarov technique has satisfactory results for treatment of Type III congenital fibular hemimelia and can be considered a good alternative to amputation. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

The external fixation in the treatment of humeral diaphyseal fractures: outcomes of 84 cases.

We retrospectively review 84 cases of diaphyseal humeral fractures (24 type A, 38 type B, 22 type C of the AO/OTA classification) treated with external fixation (Hoffmann II frame) between 1995 and 2007. Six of these fractures were complicated with radial nerve palsy. Four cases were open fractures. All reductions were achieved closely or through minimal open approaches. All fractures achieved consolidation with an average of 95 days (range 58-140). The six radial nerve palsies had complete spontaneous recovery. According to the Constant score excellent shoulder function was recorded in 54.6% of the cases, good results in 25%, fair in 13.6% and poor in 6.8%. The elbow function according to the Mayo elbow performance index was excellent in 81.8% of cases, good in 13.6%, fair in 2.3%, and poor in 2.3%. We observed superficial pin tract infections in 12% of the patients. There was no cases of deep infection. External fixation of humeral diaphyseal fractures as recorded in this case series, represents a management option, which allows straightforward fracture reduction and adequate stability, with a short operative time, excellent consolidation rate and good functional results with no major complications secondary to this type of surgery.

Treatment of traumatic forearm bone loss with Ilizarov ring fixation and bone transport.

Bone loss in the forearm results from high-energy trauma or follows non-union with infection. Ilizarov methodology provides stable fixation without implantation of permanent foreign bodies while permitting wrist and elbow movement. We are reporting our experience using distraction osteogenesis in the treatment of traumatic bone loss in the forearm. From 1991 to 2000, 11 consecutive patients with traumatic forearm bone loss were treated with Ilizarov ring fixation. Records were reviewed retrospectively. All patients were contacted 2-10 years after surgery at the Ilizarov Clinic in Lecco, Italy. Eleven atrophic non-unions with bone loss were treated. The time from injury to Ilizarov treatment averaged 2.1 years. Follow-up averaged 6.2 years. The union rate with Ilizarov treatment alone was 64%. Thirty-six percent of the patients were converted to a hypertrophic non-union and underwent compression plating. The overall rate of union was 100%. There were four unplanned reoperations and no refractures, neurovascular injuries or deep infections. Three patients had significant limitations of wrist function. Nine patients described their function as excellent. Ilizarov fixation with bone transport is a viable treatment option for atrophic forearm non-unions with bone loss. Treatment resulted in ablation of infection, healing of atrophic non-unions with minimal complications and early extremity use.