Aims

The aim of the present study was to assess the outcomes of the induced membrane technique (IMT) for the management of infected segmental bone defects, and to analyze predictive factors associated with unfavourable outcomes.

Introduction

Reconstruction of large defect of tibia following infection is considered as one of the most difficult problem facing the orthopaedic surgeon. Amputation with modern prosthetic fitting is a salvage procedure to treat big defects, which gives a functional result with unpredictable psychological impact.

The December 2022 Trauma Roundup³⁶⁰ looks at: Anterior approach for acetabular fractures using anatomical plates; Masquelet–Ilizarov for the management of bone loss post debridement of infected tibial nonunion; Total hip arthroplasty – better results after low-energy displaced femoral neck fracture in young patients; Unreamed intramedullary nailing versus external fixation for the treatment of open tibial shaft fractures in Uganda: a randomized clinical trial; The Open-Fracture Patient Evaluation Nationwide (OPEN) study: the management of open fracture care in the UK; Cost-utility analysis of cemented hemiarthroplasty versus hydroxyapatite-coated uncemented hemiarthroplasty; Unstable ankle fractures: fibular nail fixation compared to open reduction and internal fixation; Long-term outcomes of randomized clinical trials: wrist and calcaneus; ‘HeFT’y follow-up of the UK Heel Fracture Trial.

Aims

The aim of this retrospective cohort study was to assess and investigate the safety and efficacy of using a distal tibial osteotomy compared to proximal osteotomy for limb lengthening in children.

Aims

This observational cross-sectional study aimed to answer the following questions: 1) how has nonunion incidence developed from 2009 to 2019 in a nationwide cohort; 2) what is the age and sex distribution of nonunions for distinct anatomical nonunion localizations; and 3) how high were the costs for surgical nonunion treatment in a level 1 trauma centre in Germany?

Aims

The timing of when to remove a circular frame is crucial; early removal results in refracture or deformity, while late removal increases the patient morbidity and delay in return to work. This study was designed to assess the effectiveness of a staged reloading protocol. We report the incidence of mechanical failure following both single-stage and two stage reloading protocols and analyze the associated risk factors.

Aims

Treatment for delayed wound healing resulting from peripheral vascular diseases and diabetic foot ulcers remains a challenge. A novel surgical technique named ‘tibial cortex transverse transport’ (TTT) has been developed for treating peripheral ischaemia, with encouraging clinical effects. However, its underlying mechanisms remain unclear. In the present study, we explored the potential biological mechanisms of TTT surgery using various techniques in a rat TTT animal model.

Introduction. Infected big gap non-union of femur and tibia are difficult to treatment because of infection, bone loss, shortening, poor sift tissue over and deformity. Step by step management and definitive treatment by Ilizarov fixator was achieved in our cases. Materials and Methods. A long defect which is more than 10cm in femur and tibia because of infection and gap, tumor resection, traumatic loss, which is very difficult to treat by conventional method and that's why we treated that type defect by Tibialization of fibula with Ilizarov technique. Management of infected big gap non-union of the femur include debridement and bone transport by Ilizarov technique by using Ilizarov fixator we can correct deformities, regenerate new bone without bone grafting, correct LLD and patient can weight bear during the course of treatment. We retrospectively reviewed records of 246 consecutive patients who underwent distraction osteogenesis using Ilizarov compression-distraction device for infected big gap INU of femur and tibia from 2000 to 2020. Results. All healed with the application of Ilizarov fixator, 5 needed reapplications of Ilizarov to achieve 100% union. 210 were excellent, 25 good and 6 were fair by ASAMI criteria. Mean Ilizarov duration was 366 days (130–250). Mean 8.2 cm length was achieved in the regenerate. Conclusions. A well plan step by step Ilizarov technique to cover infected gap non-union of femur and tibia is an excellent method in challenging cases. Excellent results cannot be achieved with conventional methods but can be easily achieved with Ilizarov technique within 1–2 years

Introduction. Fibrous dysplasia is a pathological condition, where normal medullary bone is replaced by fibrous tissue and small, woven specules of bone. Fibrous dysplasia can occur in epiphysis, metaphysis or diaphysis. Occationally, biopsy is necessary to establish the diagnosis. We present a review of operative treatment using the Ilizarov technique. The management of tibial fibrous dysplasia in children are curettage or subperiosteal resection to extra periosteal wide resection followed by bone transport. Materials and Methods. A total of 18 patients were treated between 2010 – 2020; 12 patients came with pain and 6 with pain and deformity. All patients were treated by Ilizarov technique. Age ranges from 4–14 years. 12 patients by enbloc excision and bone transportation and 6 patients were treated by osteotomy at the true apex of the deformity by introducing the k/wires in the medullary cavity with stable fixation by Ilizarov device. The longest duration for bone transport was 16 weeks (14–20 weeks) for application, after deformity correction was 20 weeks. We have never used any kind of bone grafts. Results. All the 18 patients were treated successfully by Ilizarov compression distraction device. The patients with localized tibial pathology with deformity had the shortest period on the Ilizarov apparatus, 14 weeks. Conclusions. Preservation and bone regeneration by distraction histogenesis constitutes a highly conservative limb saving surgery. Patients with bone defects of <10 cm, a great deal of preserved healthy tissue and good prognosis are good candidates for these methods

Introduction and Objective. Management of gap non-union of the tibia, the major weight bearing bone of the leg remains controversial. The different internal fixation techniques are often weighed down by relatively high complication rates that include fractures which fail to heal (non-union). Minimally invasive techniques with ring fixators and bone transport (distraction osteogenesis) have come into picture as an alternative allowing alignment and stabilization, avoiding a graduated approach. This study was focused on fractures that result in a gap non-union of > 6 cm. Ilizarov technique was employed for management of such non-unions in this case series. The Ilizarov apparatus consists of rings, rods and kirschner wires that encloses the limb as a cylinder and uses kirschner wires to create tension allowing early weight bearing and stimulating bone growth. Ilizarov technique works on the principle of distraction osteogenesis, that is, pulling apart of bone to stimulate new bone growth. Usually, 4–5 rings are used in the setup depending on fracture site and pattern for stable fixation. In this study, we demonstrate effective bone transport and formation of gap non-union more than 6 cm in 10 patients using only 3 rings construct Ilizarov apparatus. Materials and Methods. This case study was conducted at Dr. D. Y. Patil Medical Hospital, Navi Mumbai, Maharashtra, India. The study involved 10 patients with a non-union or gap > 6 cm after tibial fracture. 3 rings were used in the setup for the treatment of all the patients. Wires were passed percutaneously through the bone using a drill and the projecting ends of the wires were attached to the metal rings and tensioned to increase stability. The outcome of the study was measured using the Oxford Knee scoring system, Functional Mobility Scale, the American Foot and Ankle Score and Visual Analog Scale. Further, follow up of patients was done upto 2 years. Results. All the patients demonstrated good fixation as was assessed clinically and radiologically. 9 patients had a clinical score of > 65 which implied fair to excellent clinical rating. The patients showed good range of motion and were highly satisfied with the treatment as measured by different scoring parameters. Conclusions. In this case study, we demonstrate that the Ilizarov technique using 3 rings is equally effective in treating non-unions > 6 cm as when using 4–5 rings. Obtaining good clinical outcome and low complication rate in all 10 patients shows that this modified technique can be employed for patients with such difficulties in the future

Aims

In contrast to operations performed for other fractures, there is a high incidence rate of surgical site infection (SSI) post-open reduction and internal fixation (ORIF) done for tibial plateau fractures (TPFs). This study investigates the effect of induced membrane technique combined with internal fixation for managing SSI in TPF patients who underwent ORIF.

Introduction. Correction of multiplanar bone deformities in children is indicated for prevention of secondary orthopaedic complications. Different problems related to surgical intervention were reported: non-union, delayed union, recurrent deformity, refracture, nerve palsy and pin tract infection. The aim of this study was to show the results of children femur and tibia bowing deformities by Ilizarov technique. Materials and Methods. We analysed 27 cases of children femur and tibia bowing deformities under the age of 13 yrs. Simultaneous deformity correction in femur and tibia was done with Ilizarov device in ipsilateral side. Contralateral side was operated after 14 days. Results. The duration of Ilizarov fixation was 130 days on an average. The deformity correction was achieved with a proper alignment in all the cases. Conclusions. Bowing of femur and tibia can be corrected simultaneously by Ilizarov fixation with minimum complications. There were no recurrent deformities in our cases

Introduction. Critical limb ischemia (CLI) is the reduced blood flow in the arteries of the lower extremities. It is a serious form of peripheral arterial disease, or PAD. If left untreated the complications of CLI will result in amputation of affected limb. The treatment experience of diabetic foot with transverse tibial transport was carried out by Ilizarov technique. Madura foot ulcer is not a common condition. It disturbs the daily activities of the patient. Pain swelling with multiple nodules with discharging sinus with discoloration(blackening) of the affected area is the main problem. Materials and Methods. We treated total case: 36 from Jan. 2003 – Jan. 2020 (17yrs.). Among these-. TAO- 20. Limb Ishchemia- 5. Diabetic Foot- 9. Mycetoma pedis- 2. Infected sole and dorsum of the foot- 5. Results. Transverse corticotomy and wire technique followed by distraction increases blood circulation of the lower limbs, relieving the pain. The cases reported here were posted for amputation by the vascular surgeons, who did not have any other option for treatment. Hence we, re-affirm that Academician Prof. Ilizarov's method of treatment does help some patients suffering from these diseases. Conclusions. By Ilizarov compression distraction device for TAO, modura foot ulcer, diabetic foot ulcer, mycetoma pedis ulcer, infected sole and dorsum of the foot ulcer were treated by introducing K/wires through the bones with proper vertical corticotomy. Application of this noble device will bring angeogenesis within the reach of all deserving patients

Introduction. The aim of the study is to evaluate the results of using Ilizarov technique for correcting the post traumatic lower limb deformities. Materials and Methods. This prospective study included 25 femurs (Group A) and 65 tibias (Group B) underwent correction with Ilizarov technique and frame. Both groups had moderate and complex deformed segments. Outcomes were Ilizarov correction time, distraction index (DI), consolidation index (CI), Ilizarov index (II) and complications. Results. Within group A, mean correction of frontal plane deformity was 15°, sagittal plane was 10° rotational deformity was 20°. In group B, mean correction of frontal plane deformity was 19°, sagittal plane was 12° and rotational deformity was 10°. Conclusions. Ilizarov provided easy, accurate and excellent lower limb deformity correction and lengthening

Introduction. The objective of this study is to report the first cases of femoral lengthening in children using Ilizarov fixator. Materials and Methods. We carried out a retrospective study about the cases of femoral lengthening done in 2010 to 2020 in our BARI-ILIZAROV Orthopaedic centre Dhaka. Results. 48 lengthening were done during this period using Ilizarov fixator. The procedure was done incongenital bone diseases in 20 cases and after a distal femoral epiphysiodesis in 10 cases. The mean age at surgery was 12.8 years. Lengthening was required in all patients and an axis correction was required in 16 of 26 cases. The mean lengthening was 5.9 cm. The healing index was 45.5 day/cm (25.5–62). We noticed 8 knee stiffness and 5 broken wires. Knee Stiffness were corrected by Judet'squadricepsplasty and 6 broken wires were replaced by new wires. The goal of lengthening was reached in all cases. The goal of axis correction was reached in 98.5% of cases. Conclusions. Ilizarov technique allows to do accurate lengthening and axis correction and it is a unique reliable external fixator for femoral lengthening in children

Aims

To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (β-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes.

Aims

The treatment of tibial aplasia is controversial. Amputation represents the gold standard with good functional results, but is frequently refused by the families. In these patients, treatment with reconstructive limb salvage can be considered. Due to the complexity of the deformity, this remains challenging and should be staged. The present study evaluated the role of femoro-pedal distraction using a circular external fixator in reconstructive treatment of tibial aplasia. The purpose of femoro-pedal distraction is to realign the limb and achieve soft tissue lengthening to allow subsequent reconstructive surgery.

Aims

Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis.

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.

Aim. Simultaneous use of Ilizarov techniques with transfer of free muscle flaps is not current standard practice. This may be due to concerns about duration of surgery, clearance of infection, potential flap failure or coordination of surgical teams. We investigated this combined technique in a consecutive series of complex tibial infections. Method. A single centre, consecutive series of 45 patients (mean age 48 years; range 19–85) were treated with a single stage operation to apply an Ilizarov frame for bone reconstruction and a free muscle flap for soft-tissue cover. All patients had a segmental bone defect in the tibia, after excision of infected bone and soft-tissue defects which could not be closed directly or with local flaps. We recorded comorbidities, Cierny-Mader and Weber-Cech classification, the Ilizarov method used, flap type, follow-up duration, time to union and complications. Results. 26 patients had osteomyelitis and 19 had infected non-union. Staphylococci were cultured in 25 cases and 17 had polymicrobial infections. Ilizarov monofocal compression was used in 14, monofocal distraction in 15, bifocal compression/distraction in 8, and bone transport in 8. 8/45 had an additional ankle fusion, 7/45 had an angular deformity corrected at the same time and 24 also had local antibiotic carriers inserted. Median time in frame was 5 months (3–14). 38 gracilis, 7 latissimus dorsi and 1 rectus abdominus flaps were used. One flap failed within 48 hours and was revised (flap failure rate 2.17%). There were no later flap complications. Flaps were not affected by distraction or bone transport. Mean follow-up was 23 months (10–89). 44/45 (97.8%) achieved bony union. Recurrence of infection occurred in 3 patients (6.7%). Secondary surgery was required to secure union with good alignment in 8 patients (17.8%; docking site surgery in 6, IM nailing in 2) and in 3 patients for infection recurrence. All were infection free at final follow-up. Conclusions. Simultaneous Ilizarov reconstruction with free muscle flap transfer is safe and effective in treating segmental infected tibial defects, and is not associated with an increased flap failure rate. It shortens overall time spent in treatment, with fewer operations per patient. However, initial theatre time is long and a committed multidisciplinary team is required to achieve good results