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 lengthening: what are the limits?

OBJECTIVES: In the last decades, limb lengthening has not been limited to the treatment of patients with dwarfism and deformities resulting from congenital anomalies, trauma, tumor and infections, but, has also been used for aesthetic reasons. Cosmetic lengthening by the Ilizarov method with circular external fixation has been applied to individuals with constitutional short stature who wish to be taller. MATERIALS AND METHODS: From January 1985 to December 2010, the medical records of 63 patients with constitutional short stature (36 M, 27F; 126 legs) who underwent cosmetic bilateral leg lengthening using a hybrid advanced fixator according to the Ilizarov method, were reviewed, retrospectively. The mean age was 24.8 years, while the mean preoperative height was 152.6 cm. Paley's criteria were used to evaluate problems, obstacles, and complications from the time of surgery until 1 year after frame's removal. RESULT: The mean lengthening achieved in all patients was 7.2 cm (range: 5-11 cm), with a mean duration of treatment of 9 months and 15 days (range: 7-18 months). The mean follow-up time was 6.14 years (range 1-10). CONCLUSION: The cosmetic leg lengthening was helpful to all patients, improving their social capabilities and self-confidence. All patients considered their stature as normal and they reported satisfaction and gratification with important changes in their professional and personal life. Cosmetic leg lengthening may raise some ethical objections and for that reason patients should be well informed about all the risks and complications related to this type of surgery.

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. 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.

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.

Extensimetric monitoring of healing in the treatment with the Ilizarov apparatus. A multicenter clinical trial.

The results of a multicentric review are reported using the extensimetric instrumentation applied to the Ilizarov device. This clinical trial the follows same theoretical and experimental preliminary studies, outlines the advantages and current limits of the method, and sets the bases for further clinical and experimental research.

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.

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.

Two cases of periosteal chondroma.

One of our 2 cases of periosteal chondroma of the tibia recurred three times before definitive cure, and required extensive radiographic and histologic evaluation to avoid overinterpreting the malignancy. Our experience confirms that marginal excision should be employed.