Background:

Developing a successful outpatient service for Ilizarov frame removal provides both patient and cost benefits. Misinformation and patient trepidation can be detrimental to recovery and influence choices. Education may play an important role in tailoring an efficacious service.

Background:

Delay in fracture healing is a complex clinical and economic issue for patients and health services. Established non-unions are debilitating and often difficult to treat. Bone morphogenic proteins (BMPs) may play an important role in bone and cartilage formation, fracture healing and the repair of other musculoskeletal tissues. There is, however, a paucity of data on the use of BMPs in fracture healing and to date its role remains unclear.

Introduction

Paediatric tibial fractures, unlike femoral fractures do not have much potential for overgrowth. In simple factures of the tibial shaft treated non-operatively the major problems are shortening and malunion.

In complex injuries with extensive soft tissue disruption and bone loss, the long-term aim of reconstruction is to achieve union with a fully functional limb without limb-length inequality.

Limb lengthening is described by means of external fixator in limb length discrepancy. Intramedullary distraction is a relatively new procedure undertaken infrequently. We present our initial results following the use of the ISKD for lower limb lengthening.

Methods: A retrospective review, over a three year period, revealed six patients (five femurs and one tibia) underwent lengthening by ISKD. Four of the femoral cases were secondary to trauma. The other femoral case and tibial case were secondary to congenital shortening.

All cases were male with mean age of 35 years (20 – 54 years). The mean total distraction was 42mm (10 – 65mm) and a mean daily distraction of 0.96mm/day (0.78 – 1.75mm). Mean time to full weight bearing was 12.5 weeks. The planned length of distraction was achieved in all patients undergoing femoral lengthening. Four of these patients regained full movement of the knee at 6 months and the other regained an arc of 5 – 105 degrees.

The tibial lengthening only achieved 28.5% of the desired length as a result of premature consolidation and poor patient compliance. There were no cases of infection, DVT, non-union or hardware failure. Three patients experienced no complications. One patient experienced premature consolidation and required repeat corticotomy. Two patients experienced inappropriate lengthening. One experienced distraction at the previous fracture site and as a result required 5 further operations and application Ilizarov frame. The other was as a result of a runaway nail achieving 56mm distraction in 32 days (1.75mm/day).

This review, although with small numbers, highlights that the ISKD is a satisfactory treatment for femoral lengthening although we experienced difficulties with tibial lengthening. Following our experience all patients require a CT scan preoperatively to confirm union at the fracture site. ISKD has been considered an option for femoral lengthening only.

Introduction: Paediatric tibial fractures, unlike femoral fractures do not have much potential for overgrowth. In simple factures of the tibial shaft treated non-operatively the major problems are shortening and malunion.

In complex injuries with extensive soft tissue disruption and bone loss, the long-term aim of reconstruction is to achieve union with a fully functional limb without limb-length inequality.

Methods: Four children who sustained high-energy grade III open fractures of the tibia were treated with acute shortening and bone transport. Any soft tissue reconstructive and secondary grafting procedures for delayed union were recorded. The children were prospectively followed up to fracture union. Distraction ostegenesis proceeded until limb length equality was achieved and the regenerate allowed to consolidate.

Discussion: Despite achieving equal limb lengths at the end of distraction osteogenesis the injured tibia overgrew by 1–2cm at three years post injury. This would suggest that even in the presence of extensive soft tissue trauma, as seen in these high energy injuries, the increased blood flow associated with metaphyseal corticotomy stimulates epiphyseal activity resulting in overgrowth. The value of stopping adjustments just short of achieving limb length equality to allow for expected overgrowth in the injured tibia merits further investigation.

Aims: To quantify the complication rate in Ilizarov surgery at an experienced Limb reconstruction Unit. Study Design: A retrospective study of prospectively collected data on complications. Material: Complications in 304 patients, treated between January 1998 and April 2001 were reviewed. Complications relating to the pin site, bones, joints, neurovascular structures, pain, mental status and mechanical failure of the frame were documented. Results: There were 103 complications (34%) in total. Twenty patients (6.6%) required IV antibiotics or curettage of a ring sequestrum. Forty- three (14%) experienced problems with non or delayed union, mal union, incomplete osteotomy, premature consolidation of regenerate or fracture through a pin site. Twelve (4%) developed neural problems in the form of nerve pain or permanent nerve damage. Twenty-one (6.9%) developed loss of joint motion sufþcient to stop distraction or as a permanent sequelae. One (0.3%) suffered from depression during treatment. Three (1%) required referral to a pain team. Despite re-useable hardware mechanical failure was represented by only 3 episodes (1%) of þne wire breakage. Conclusions: Analysis revealed no signiþcant difference between the calendar years and so represents a true complication rate. There was a signiþcant difference in the complication rate for frames applied for acute trauma, late trauma and elective surgery. The difference did not relate to time spent in the frame and seems to represent a separate variable. There was a disproportionate increase in complications for frames applied for upper limb pathology.

Aim: To quantify the complication rate in Ilizarov surgery. This study establishes the complication rate for an experienced Limb Reconstruction Team composed of 3 surgeons, 2 specialist nurses and 2 physiotherapists involved with acute trauma, late trauma reconstruction and elective limb deformity cases.

Study Design: Retrospective analysis of prospectively collected data on complications.

Material: Complications in 304 patients, treated between January 1998 and April 2001 were reviewed. Complications relating to the pin site, bones, joints, neurovascular structures, pain, mental status of the patient and mechanical failure of the frame were documented.

Results: Of the 304 cases treated there were 103 complications (34%) in total. Twenty patients (6.6%) required re-admission for IV antibiotics or curettage of a ring sequestrum secondary to a pin site infection. Forty three patients (14%) experienced problems with non or delayed union, mal union, incomplete osteotomy, premature consolidation of the regenerate or fracture through a pin site. Twelve patients (4%( experienced neural problems in the form of nerve pain during distraction or permanent nerve damage. Twenty-one patients (6.9%) developed loss of joint motion sufficient to stop distraction or as a permanent sequelae of treatment. One patient (0.3%) suffered from depression during the period of treatment. Three patients (1%) required referral to the pain team. Mechanical failure of the frame was represented by three episodes (1%) of fine wire breakage despite re-useable hardware.

Analysis revealed no significant difference in complication rates between the calendar years. However, there was a significant difference between complication rates in frames applied for acute trauma, late presentation of trauma, and elective surgery. This difference did not appear to relate to time spent in the frame, and therefore seems to represent a separate variable. There was a disproportionate increase in complications in Ilizarov frames applied for upper limb problems.

Conclusion: This study provides a baseline for the commonly occurring problems associated with the practice of Ilizarov surgery in the United Kingdom and Ireland.

Z-plasty is used to lengthen scars and wounds. We describe the use of a modified technique to shorten wounds in ten consecutive patients undergoing acute shortening of a limb as part of an Ilizarov procedure. The modified technique gave good exposure, easy closure of the wound and fewer problems with healing than standard incisions.