Correction of lower limb deformities in children with renal osteodystrophy by the Ilizarov method.

BACKGROUND: Children with renal osteodystrophy (ROD) may develop severe angular deformities of the limbs. Various methods, both medical and surgical, have been described for correction of these deformities, but a literature search showed only 1 child previously treated by the Ilizarov method. The purpose of this study was to characterize the deformities found in our group of patients and to describe our experience in treating these patients with the Ilizarov method. METHODS: Correction of angular deformity by the Ilizarov method was performed on 8 limb segments in 5 patients with ROD. Mean age was 14.9 years. Two patients were on hemodialysis, and 3 had functioning kidney grafts. Surgery was deferred until stabilization of metabolic parameters. RESULTS: There was 1 varus and 7 valgus deformities. Preoperative coronal deformity averaged 29 degrees (18-38 degrees). The Ilizarov apparatus was used in all cases. Correction time averaged 23 days (20-28 days). The time from completion of correction to frame removal averaged 71 days (48-113 days). There were no changes in metabolic parameters or frequency of hemodialysis throughout the treatment. Restoration of a normal mechanical axis was achieved in 4 of the 5 patients. One case failed due to intraarticular instability. There were no major complications. Minor complications included pin tract infections, which responded to antibiotic treatment, and premature consolidation in 1 case. Follow-up averaged 6.5 years (1-10 years). The alignment obtained at surgery was maintained in all 4 patients, and they are functional and symptom-free. The patient for whom the surgery failed remains wheelchair-bound. CONCLUSIONS: The Ilizarov method was found to be safe and effective for correction of malalignment due to ROD. Optimization of metabolic parameters is essential before surgery and throughout correction. The procedure is contraindicated in patients with significant intraarticular knee pathology.

The distally based sural musculoneurocutaneous flap for treatment of distal tibial osteomyelitis.

BACKGROUND: The treatment of distal tibial osteomyelitis represents a challenge for orthopedic and plastic surgeons. The affected tissues should be debrided and good vascularized tissue should cover the defect, but the option of a muscle flap covering the area is limited. Free flaps are used but require longer operating time and experience with microsurgery, may result in donor-site morbidity, and sometimes add bulky tissue to the area. The authors present their experience with a sural musculoneurocutaneous flap for the treatment of chronic osteomyelitis of the distal tibia. METHODS: Over a 2-year period, nine distally based sural musculoneurocutaneous flaps were used in the treatment of chronic osteomyelitis of the distal tibia. Four patients had comorbid conditions (smoking, diabetes mellitus, venous insufficiency, or obesity). The clinical aspect was represented by drainage sinuses located in the distal part of the tibia. Five patients had postsurgical scars on the lateral malleolar region and one had medial and lateral malleolar scarring. Three patients had an Ilizarov device at the time of wound coverage. RESULTS: All wounds were closed successfully. Dehiscence surrounding the flap was encountered in a single case that was attributable to inadequate bone debridement; this flap was raised to allow extending the debridement, and a local medial fasciocutaneous flap completed wound coverage. Distal tip necrosis of the flap was encountered in two cases. CONCLUSIONS: The sural musculoneurocutaneous sural flap was successfully used for treatment of distal tibia osteomyelitis. Although it is believed that lateral malleolar scars might compromise the flap, the flaps in the authors' series survived. This flap can also be applied to patients with external fixators without removing the apparatus.