The traditional techniques involving an oblique tunnel or triangular wedge resection to approach a central or mixed-type physeal bar are hindered by poor visualisation of the bar. This may be overcome by a complete transverse osteotomy at the metaphysis near the growth plate or a direct vertical approach to the bar. Ilizarov external fixation using small wires allows firm fixation of the short physis-bearing fragment, and can also correct an associated angular deformity and permit limb lengthening.

We accurately approached and successfully excised ten central- or mixed-type bars; six in the distal femur, two in the proximal tibia and two in the distal tibia, without damaging the uninvolved physis, and corrected the associated angular deformity and leg-length discrepancy. Callus formation was slightly delayed because of periosteal elevation and stretching during resection of the bar. The resultant resection of the bar was satisfactory in seven patients and fair in three as assessed using a by a modified Williamson–Staheli classification.

Cite this article: Bone Joint J 2015;97-B:1726–31.

Abstract. The specific methods of skeletal reconstruction of massive bone loss remains a topic of controversy. The problem increased in case of massive bone loss, extensive soft tissue scar, vascular compromise, and short tibial remnants. Aim of the work. We evaluate the use of fibula in association of Ilizarov external fixator in management of massive post traumatic bone loss of tibial shaft. Materials and methods. Between December 1999 and 2004, we treated 8 adult patients with bone loss 10 cm and more. The indication was massive bone loss, extensive soft tissue scar, vascular compromise, and short tibial remnants. Whole fibula was used in 6 conditions and partial fibula in 2. The average age was 30.5 years (range: 25:51). The fibulas were prepared for transfer either as a whole or partially transfer. Ilizarov device was applied with a special construct for each condition accordingly. Free latismus dorsi was applied in 1 patient, and fasciocutanious flaps in 2. Four patients with whole fibula transfer continued to wear orthosis for outdoor activities. Results. The mean follow-up period was 40 months (range: 24:96) after healing. All fractures heeled between 8 and 24 months. Conclusion. We concluded that the Ilizarov external fixator is effective in management of management of massive post traumatic bone loss of tibial shaft. It provides advantages of compensation of bone defects, length, and early rehabilitation. It has the disadvantages of long healing time, long orthotic support. Its advantages are clear in case of massive bone loss, extensive soft tissue scar, vascular compromise, and short tibial remnants

We review the results of a modified quadricepsplasty in five children who developed stiffness of the knee after femoral lengthening for congenital short femur using an Ilizarov external fixator which spanned the knee. All had a full range of movement of the knee before lengthening was undertaken. Unifocal lengthening was carried out in the distal metaphysiodiaphyseal region of the distal femur with a mean gain of 6.5 cm. The mean percentage lengthening was 24%. At the end of one year after removal of the Ilizarov frame and despite intensive physiotherapy all patients had stiffness. Physiotherapy was continued after the quadricepsplasty and, at the latest follow-up (mean 27 months), the mean active flexion was 102° (80 to 130). The gain in movement ranged from 50° to 100°. One patient had a superficial wound infection which settled after a course of oral antibiotics. None developed an increased extension lag after surgery and all were very satisfied with the results. Quadricepsplasty is a useful procedure for stiffness of the knee after femoral lengthening which has not responded to physiotherapy

Conventional surgical treatment of relapsed or neglected club foot deformities is not always successful or easy to apply. The presence of shortened neurovascular structures and unhealthy skin may preclude the surgical interference. Bone resection in severe deformities results in short foot which is not satisfactory functionally and cosmetically. Objectives. In this study we evaluate the use of the bloodless technique for management of relapsed or neglected club foot deformities. Methods. From Jan 2000–2006, 64 cases older than 2 years with relapsed or neglected club foot deformities were referred to our center. Four cases were excluded because of inadequate follow up data. This thesis based on 60 consecutive cases (67 feet). The patients average age was 8 years and 4 months (range, 2–16 years). Seven cases were bilateral, 20 Left sides, and 34 Right sides. There were 57 relapsed club foot (5 bilateral), and 3 cases were neglected (2 bilateral). Patients with relapsed club foot had average 3 previous operations (range, 1–8 operations). There was no preoperative assembling of the apparatus. The construct was designed according to the condition of deformity: equinus, varus forefoot etc. Additional procedures, elongation of tendoachilis was done concomitantly with the original procedure in 10 cases. The patients were discharged from the hospital the same day of the operation. Results. The range of operative time was 1–3 hours with an average of 1.5 hours. Average time in the fixator was 19.6 weeks (range, 10 weeks–38 weeks). After fixator removal cast was applied for 2 months, followed by night splint and special shoes for their daily activities. The average follow-up period was 30.6 months (range, 12–84 months) after fixator removal. The results were good in 55 feet, fair in 9, bad in 3. Complications. All cases suffered from some sort of pin tract inflammation. For 8 cases: one of the wires had to be removed without anaesthesia due to persistent infection. For 3 cases: replacement of wires under general anaesthesia was performed. Oedema developed in the leg and dorsum of the foot or the ankle in 34cases. Frame adjustment under general anaesthesia in 3 cases. There are others such as: migration of the calcanean wire, 2 cases; over correction with valgus heel, two cases; flatfoot, 4 cases; talar subluxationin, 2 cases; talonavicular subluxation, one case; first metatarsophalangeal subluxation, 2 cases; flat topped talus, one case; broken wire, 2 cases and recurrence in 2 cases. Discussion. It seems logic that osteotomy of the tarsus must be carried out whenever skeletal growth of the foot is at such an advanced stage that correction can not be established by means of articular repositioning and remodeling. However, equinovarus deformity of the foot in 65 adults (38 feet) was treated by external fixator without open procedure (Oganesyan et al, 1996). After an average follow-up 10 years, satisfactory results were obtained in all feet except four. Conclusion. Ilizarov Treatment is lengthy, difficult, fraught with complications, and a technically demanding procedure. However, the complications did not affect the final outcome too much. Ilizarov method also offers the advantage of performing many additional procedures for other associated lower limb deformity. We believe that the bloodless technique using Ilizarov external fixator is an effective method in treating relapsed or neglected club foot deformities

Purpose of the study. The aim of this mechanical study was to investigate the ability of cannulated fixation bolts to stop wire slippage in Ilizarov circular external fixators. Methods and Results. Three types of cannulated fixation bolts (Smith and Nephew, Orthofix and one designed by the authors) were tested on Ilizarov rings to compare their performance. Three levels of bolt torques were applied and the wires were pulled to measure the load at which the wire will start to slip or fail. It was revealed that the initial resistance to slippage is due to plastic deformation of the wire under the clamp and is in fact governed by the size of this deformation. The slippage was found to occur in a slip/stick fashion, as the plastic deformation was propagated along the wire. Conclusion. The more the plastic deformation caused by the bolt on the wire the higher the initial resistance to loading

We report our experience of the use of callus distraction with a monolateral fixator for the treatment of acquired radial club-hand deformity after osteomyelitis. Between 1994 and 2004, 13 patients with a mean age of eight years (4 to 15) were treated by callus distraction with a monolateral fixator after a preliminary period of at least four weeks in a corrective short-arm cast.

All patients achieved bony union and were satisfied with the functional and cosmetic outcome. There were no major complications, but three patients required cancellous bone grafting at the docking site for delayed union. Local treatment and oral antibiotics were required for pin-site infection in six patients. There were no deep infection or recurrence of osteomyelitis.

Congenital unilateral anterolateral tibial bowing in combination with a bifid ipsilateral great toe is a very rare deformity which resembles the anterolateral tibial bowing that occurs in association with congenital pseudarthrosis of the tibia. However, spontaneous resolution of the deformity without operative treatment and with a continuously straight fibula has been described in all previously reported cases. We report three additional cases and discuss the options for treatment. We suggest that this is a specific entity within the field of anterolateral bowing of the tibia and conclude that it has a much better prognosis than congenital pseudarthrosis of the tibia, although conservative treatment alone may not be sufficient.