Introduction: The accepted treatment for unstable displaced tibial shaft fractures in adults is primary closed reduction and intramedullary nailing. However, this method poses a problem when treating young adolescents whose epiphyseal plates have not yet closed. We used the Ilizarov external fixation as an alternative method of treatment for these patients.

Patients and Methods: 13 patients with displaced unstable tibial shaft fractures (11 boys, 2 girls; age 13 to 16 yrs), of which 5 were open (Gustilo I–II), were treated by this method from 1995–2000. The Ilizarov frame was applied to 3 patients within the first 2 days of injury, a further 6 during the 1st week and 4 on the 2nd week or later.

All patients were allowed to weight bear from the first postoperative week. Physiotherapy was started immediately after operation and continued until normal knee and ankle function was regained. Dynamization was done in all cases 2 weeks before removal of frame. Following removal, the patients were advised to use crutches for an additional two weeks.

Results: A good or excellent alignment with full ROM in the ankle and knee joints was obtained in all patients. There were no cases of delayed or non-union. No cases of contractures or nerve injuries were reported. Superficial pin tract infection was seen in 6 patients, treated by antibiotics and local care. No cases of osteomyelitis or deep infection occurred. Length of fixation was 8–15 weeks (mean 11 weeks).

Conclusions: This method permits fixation without danger of injury to the epiphysis in growing adolescents. The stability of the fixator allows early weight bearing and leaves the adjacent joints mobile. There is no necessity for POP after removal of frame. Due to early weight bearing and an unrestricted joint movement less muscle wasting occurs. The healing time is relatively shorter than in other methods of the treatment and the complications rate was low in the presented series.

Introduction: During the last decade the Ilizarov method of limb lengthening has provided a solution for many patients with short stature, suffering not just from cosmetic problems, but having functional disability as well. The aim of this presentation is to discuss our experience of physiotherapy at all stages of treatment, from pre-operative evaluation to the final adaptation of the patient to his new limb condition and the problems that evolved and our solution to them.

Patients and Methods: Over the past six years, five patients underwent limb lengthening. Two had achrondoplasia, one had proximal focal femoral dysplasia and two had metaphysical dysplasia. Physiotherapy was given to prevent pulmonary complications, maintain joint mobility and muscle strength, stretch the soft tissue, encourage weight bearing and improve gait. The main complications that occurred were short quadriceps tendon, short Achilles tendon causing equines, excessive anterior pelvic tilt, restriction of the knee joint due to tightness of the iliotibial band and non-compliance of the patient.

Results: After the completion of treatment all patients walked independently and returned at least to their pre-operative functional level. Their posture and self-confidence were improved. Average lengthening of the lower limb was 28 cm.

Discussion: Careful selection of patients, maintenance of maximal range of motion of all joints involved at every stage of the treatment and long term physiotherapy after the removal of the external fixators are essential for success. It may be important to halt the lengthening process if adequate joint motion is not achieved. It can be concluded that despite the fact that this is a lengthy and painful procedure, the end results make it worthwhile.