LIMB RECONSTRUCTION USING CIRCULAR FRAMES IN CHILDREN AND ADOLESCENTS WITH SPINA BIFIDA.

Abstract

Introduction: The management of deformities of the lower extremity in children with spina bifida is challenging. Surgery is fraught with high complication and recurrence rates. The Ilizarov technique has shown to be a successful tool in the management of complex lower limb deformity. There are few published series in the literature dealing specifically with Ilizarov correction of complex lower limb deformities in spina bifida. In this paper we present our experience of the Ilizarov technique for complex deformities in children with spina bifida.

Methods: From 1989 to 2006, 33 patients with spina bifida underwent 48 corrections of their lower extremity deformity using the Ilizarov technique at one of three tertiary care centres (Royal Children’s Hospital, Melbourne, Australia, Musgrave Park Hospital, Belfast, Northern Ireland and Birmingham Children’s Hospital, Birmingham, UK). Notes were reviewed retrospectively. Patient demographics, indications for surgery, deformity analysis and the extent of surgery were recorded. Complications of the surgery and outcomes were noted.

Results: Group I comprised of 12 fixed knee flexion deformities and one unstable neuropathic joint. Group II comprised 15 external tibial rotational deformities. Group III comprised 20 complex foot deformities. The mean age of the patients was 12.1 years (5.2–20.6 years). Prior to their treatment using the Ilizarov technique patients had undergone a mean of 1.6 previous surgeries (range: 0–5) on the affected limb. The mean duration of treatment in the frame was 9.3 weeks (range: 2–26 weeks). The mean follow-up is 4.0 years (range 0.3–9.0 years). Thirteen problems occurred in the 48 procedures (27.1%). Five obstacles occurred in the 48 procedures (10.4%). Thirteen complications occurred in the 48 procedures (27.1%). Further surgical procedures are either planned, or have been performed, in 8 of the 33 patients (24.2%). Following treatment, all feet were recorded to be plantigrade. All were comfortable in their respective orthoses where appropriate.

Conclusion: Through the pitfalls in treating the complex lower limb deformity in spina bifida, the Ilizarov technique offers a refreshing approach. It offers distinct advantages throughout the treatment period. It modifies both the intraoperative and postoperative environment to address the morbidity of the significant complications associated with the traditional approach to the correction of the limb deformity in the child with spina bifida.

Significance: This is a large series of complex limb reconstruction cases in spina bifida showing excellent results, an acceptable complication rate and recommendations for further use of this technique.