Introduction. We present a case of a 49-year-old patient who initially presented in May 2020 with an open pilon fracture. Managed with initial debridement, fixation and flap - who subsequently underwent circular frame application for failure of fixation, requiring a transport to fusion frame who developed beta-haemolytic streptococcus A within the site of the proximal
Introduction. Hip dysplasia is the most common congenital deformity of the musculoskeletal system. This is a pathology that brings the hip joint from subluxation to dislocation. Frequency of hip dysplasia − 16 children per 1000 newborns. Materials and Methods. Diagnostic methods of research are X-ray inspection which is necessarily carried out at internal rotation (rotation) of an extremity as lateral rotation of a hip on the radiograph always increases an angle of a valgus deviation of a neck. Surgical treatment is performed in the subclavian area of the femur. An external fixation device is applied and a corrective
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
Aim. Post traumatic distal tibia osteomyelitis (DTOM) with an upper ankle joint involvement is a serious complication after primary osteosynthesis and can be a nightmare for the patient and the surgeon as well. Our aim was to identify mayor complications during treatment and to find the way to prevent or treat them. Method. It is a retrospective analysis of eight patients with DTOM and an upper ankle joint involvement treated in our institution from 2012 to 2018. The average size of a bone defect after a debridement was 9 centimeters (4–15). Patients were treated in two stages. First stage was segmental bone resection, external fixation and soft tissue envelope reconstruction if necessary. At second stage a distraction frame was applied and proximal
Introduction. Bone transport and distraction osteogenesis have been shown to be an effective treatment for significant bone loss in the tibia. However, traditional methods of transport are often associated with high patient morbidity due to the pain and scarring caused by the external frame components transporting the bone segment. Prolonged time in frame is also common as large sections of regenerate need significant time to consolidate before the external fixator can be removed. Cable transport has had a resurgence with the description of the balanced cable transport system. However, this introduced increasingly complex surgery along with the risk of cable weave fracture. This method also requires frame removal and intramedullary nailing, with a modified nail, to be performed in a single sitting, which raised concern regarding potential deep infection. An alternative to this method is our modified cable transport system with early intramedullary nail fixation. Internal cables reduce pain and scarring of the skin during transport and allow for well controlled transport segment alignment. The cable system is facilitated through an endosteal plate that reduces complications and removes the need for a single-stage frame removal and nailing procedure. Instead, the patients can undergo a pin-site holiday before nailing is performed using a standard tibial nail. Early intramedullary nailing once transport is complete reduces overall time in frame and allows full weight bearing as the regenerate consolidates. We present our case series of patients treated with this modified cable transport technique. Methodolgy. Patients were identified through our limb reconstruction database and clinic notes, operative records and radiographs were reviewed. Since 2019, 8 patients (5 male : 3 female) have undergone bone transport via our modified balanced cable transport technique. Average age at time of transport was 39.6 years (range 21–58 years) with all surgeries performed by the senior author. Patients were followed up until radiological union. We recorded the length of bone transport achieved as well as any problems, obstacles or complications encountered during treatment. We evaluated outcomes of full weight bearing and return to function as well as radiological union. Results. 4/8 bone defects were due to severely comminuted open fractures requiring extensive debridement. All other cases had previously undergone fixation of tibial fractures which had failed due to infection, soft tissue defects or mal-reduction. The mean tibial defect treated with bone transport was 41mm (range 37–78mm). From the start of cable transport to removal of external fixator our patients spent an average of 201 days in frame. 7/8 patients underwent a 2-week pin-site holiday and subsequent insertion of intramedullary nail 2 weeks later. One patient had sufficient bony union to not require further internal fixation after frame removal. 10 problems were identified during treatment. These included 4 superficial infections treated with antibiotics alone and 5 issues with hardware, which could be resolved in the outpatient clinic. 1 patient had their rate of transport slowed due to poor skin quality over the site of the regenerate. 4 obstacles resulted in a return to theatre for additional procedures. 1 patient had a re-do
Aims. The aims of this study were to establish whether composite fixation
(rail-plate) decreases fixator time and related problems in the
management of patients with infected nonunion of tibia with a segmental
defect, without compromising the anatomical and functional outcomes
achieved using the classical Ilizarov technique. We also wished
to study the acceptability of this technique using patient-based
objective criteria. Patients and Methods. Between January 2012 and January 2015, 14 consecutive patients
were treated for an infected nonunion of the tibia with a gap and
were included in the study. During stage one, a radical debridement
of bone and soft tissue was undertaken with the introduction of
an antibiotic-loaded cement spacer. At the second stage, the tibia
was stabilized using a long lateral locked plate and a six-pin monorail
fixator on its anteromedial surface. A
Aims. The aim of this double-blind prospective randomised controlled
trial was to assess whether low intensity pulsed ultrasound (LIPUS)
accelerated or enhanced the rate of bone healing in adult patients
undergoing distraction osteogenesis. Patients and Methods. A total of 62 adult patients undergoing limb lengthening or bone
transport by distraction osteogenesis were randomised to treatment
with either an active (n = 32) or a placebo (n = 30) ultrasound
device. A standardised
Introduction. The BOAST (British Orthopaedic Association Standards for Trauma) guidelines do advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines including relatively aggressive bone debridement. Methods. A retrospective analysis of a single surgeon series of open pilon fractures treated between 2014 and 2019 was conducted. Injuries were graded according to the Gustillo-Anderson classification and all patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopedic Foot and Ankle Score (AOFAS) at 6 months after definitive surgery. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 (Range: 3–24) hours. Fixation with FWF (Fine Wire Frame) was performed when the wound was healed, with the mean time from primary surgery to application of FWF being 24.5 (Range: 7–60) days. Results. There was a total of 20 patients including 16 males and 4 females. The mean age was 50.45 (Range: 16–88) years. Follow-up was for an average of 23.2 (Range: 5–51) months. There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 9.3 (Range: 2–18) months. The mean AOFAS score was 66 (Range: 15–97) points. TSF was used on 18 patients, while 2 patients had an Ilizarov frame. A
Several low energy osteotomy techniques are described in the literature but there is limited evidence comparing healing indices. We present a retrospective review of two techniques to evaluate an optimum method. Method:. Two cohorts of patients underwent osteotomy of the tibia using a Gigli saw (n=15) or DeBastiani
In this paper the results of correction of bone deformities using the llizarov methods, are presented. Fifty-nine patients, 42 with malunion and 17 with mal-nonunion of tibia or femur were operated upon using the llizarov circular fixator. Another 28 cases were corrected using a unilateral device. There were: a) 30 angular deformities, 18 of which were combined with shortening, b) 21 angular deformities associated with translation and c) 36 complex, deformities including angulation, translation, shortening and malrotation. Two rings above and two below the apex of the deformity were always required. Different types of hinges were used between them, depending on the type of the deformity. The
This study compares the initial outcomes of minimally invasive techniques for single-event multi-level surgery with conventional single-event multi-level surgery. The minimally invasive techniques included derotation osteotomies using closed
Hig energy fractures of the lower limb are often associated with tibial or femoral bone loss, skin exposition with vascular and nervous injuries (Gustilo et al.). The surgical procedure is a real challenge, consisting in a temporary stabilization of the fracture associated with a plastic and/or vascular reconstruction. Once the skin and vascular injuries are recovered, the orthopaedic surgeon can remove the temporary stabilization performing a circular external fixation with bone lengthening by using the “bifocal” (one site of metaphiseal
Ten patients, who were unsuitable for limb lengthening over an intramedullary nail, underwent lengthening with a submuscular locking plate. Their mean age at operation was 18.5 years (11 to 40). After fixing a locking plate submuscularly on the proximal segment, an external fixator was applied to lengthen the bone after
We investigated the effect of bone lengthening by callotasis on longitudinal growth of the tibia in rabbits. Ninety-nine five-week-old immature rabbits were divided into five groups according to the percentage of lengthening: group I, 10%; group II, 20%; group III, 30%; group IV, 40%; and group V, sham operation without lengthening.
Conservative treatment of neoplastic bone lesions in paediatric patients may require the sacrifice of growth cartilage with subsequent hypometria or axial deviation of the lower limb. Segmental reconstructions can be made using acrylic cement and intramedullary nailing or allograft. In case of involvement of the joint, reconstruction can be performed with prosthesis or arthrodesis. These reconstruction techniques can lead to a progressive deformity associated with shortening of the limb. The resolution of legs discrepancy and axial defects in survived patients often requires more than one surgical procedure. In our Institute, the patients affected by aforementioned defects, are treated with axial or circular external fixator at completed skeletal growth. This paper refers complications and outcomes in five patients treated:. 1st case. Male, 10 years: osteosarcoma of the distal femur healed with residual shortening of 8 centimeters. – We proceeded with a double level lengthening (proximal femur and proximal tibia) using Ilizarov technique. 2nd case. Female, 8 years:distal femur osteosarcoma healed with a shortening of 6,5 centimeters. – We used the Ilizarov apparatus to achieve an elongation of cm. 7 on soft tissues allowing the subsequent bone replacement with allograft of appropriate length. 3rd case. Female, 9 years: Ewing sarcoma of the femoral shaft. The correction of the legs discrepancy (8 centimeters) was performed using the Ilizarov apparatus with a proximal tibial
Planning of surgical correction in sequelae of vitamin D-resistant rickets preliminarily requires the management of the metabolic defect with appropriate measures. In fact, surgery perfomed with the patient in a compensated metabolic condition greatly contributes to the prevention of recurrences. The deformity most frequently observed is genu varum (where femur, tibia and fibula are usually all deformed), often combined with internal torsion. Compression-distraction systems (or circular external fixators) provide an easy control of the
Aims: We wanted to study the outcome of bone transport by Ilizarovñs method in simple and complicated gap non-unions where other conventional methods have little role to play. Methods: Sixty-six consecutive patients with an age range of 23–64 years (58 males and 8 females) were included in this study. Forty-four patients (67%) had associated problems like infection, deformity and shortening along with gap non unions of varying length. All the patients were treated with ring þxators and the principles of Ilizarovñs treatment were adopted.
Fracture or periosteal elevation near epiphysis induces inflammatory vascularity which is reported in early bone lengthening literature. In this study,
Introduction and Aims: I was presented with a Land-mine victim with closed fracture of right talus, compound injury to left lower limb, and defect in heelpad. Distal third of tibia and most of hindfoot were missing. Left foot neurovascularly intact and he was able to move his toes. Aim: reconstruct left distal tibia to enable full weight-bearing. Method: Lower leg debrided. LRS applied, using proximal ring with Sheffield clamp and two rings around foot.