Purpose: End results analysis of surgical treatment of posttraumatic bone defects in the lower extremity by Ilizarov method and intramedullary nailing augmentation during consolidation.

Materials and method: Between 1990–2000,83 patients with posttraumatic bone defect (femur 26, tibia 57) with an average age of 38 years (11–65y.) were surgically treated. Open fracture was the cause of bone defect in 50 patients (60%). In the rest 33 (40%) patients, the bone defect was the result of a surgical removal of a nonviable bone due to osteomyelitis or infected non-union. The average length of bone defect was 8,5 cm. (4–20 cm.). In all cases corticotomy and application of Ilizarov device was necessary to initiate bone transport. In 26 patients the Ilizarov device was removed during consolidation and interlocking intramedullary nailing was performed. Selection criteria for changing method were: 1) delayed union at the docking site (13 pt.), 2) Intolerance of the Ilizarov device (6 pt.), 3) Angular deformity > 10 degrees (7 pt.). Radiological and clinical assessment was performed periodically. Functional recovery and bone healing were evaluated according to A.S.A.M.I criteria.

Results: Forty-eight patients (58%) presented delayed union at the docking site. In 35 patients compression- distraction was necessary to promote union. The rest 13 patients were healed using an interlocking intramedullary nailing. Three refractures needed reapplication of the Ilizarov device. Angular deformity of more than 10 degrees was found in 13 patients. Seven of them needed an osteotomy and intramedullary nailing. All bone defects were finally covered and solid bone formation resulted.

Conclusions: The Ilizarov method offers unique advantages in treatment of bone defects. The use of an interlocking intramedullary nail during consolidation, is a treatment option for delayed docking site union and prolonged treatment time.

Purpose: A clinical retrospective study of surgical treatment of chronic posttraumatic osteomyelitis by the Ilizarov method was conducted by analyzing the end results.The aim was to evaluate the efficacy of distraction osteogenesis in covering large bone defects and eradicate infection.

Materials and method: Between 1990–2000, twenty-one patients with chronic osteomyelitis were surgically treated. Inclusion criteria were: 1) active infection of more than six months and 2) bone defect (after the surgical debridement was completed) > 4cm.The average length of bone defect was 9,5 cm. (4–28cm.). In all cases corticotomy and application of the Ilizarov device was necessary to initiate bone transport.The protocol of the Association for the Study and Application of the Method of Ilizarov (A.S.A.M.I), was used to evaluate the results. All patients were examined clinically and radiographically in order to assess the proper alignment, the progress of bone healing and possible signs of infection.

Result: Thirteen patients (62%) presented delayed union at the docking site. In 4 patients compression –distraction was necessary to promote union. In 9 patients (43%) the Ilizarov device was removed and interlocked intramedullary nailing was performed after eradication of the infection was confirmed by clinical and laboratory data. Recurrence of infection occurred in one patient. Elimination of infection and solid bone formation was the end result for all patients. Two refractures at the docking site needed reapplication of an Ilizarov device. In one case angular deformity of more than 10 degrees needed correctional osteotomy.

Conclusions: The Ilizarov method addresses successfully infection, bone defect, deformity, and leg length discrepancy simultaneously. All these may coexist in difficult cases of chronic osteomyelitis. Complications associated specifically with bone transport in exceeded bone defects ,after radical resection of infected bone, include certainly delayed union or non-union at the docking site and prolonged treatment time.

Purpose: To present our clinical experience of intramedullary nail application during the consolidation phase after bone lengthening or bone transport.

Material and method: Thirty patients (33 cases) with secondary intramedullary nailing during consolidation phase after callus distraction with an external devise (Ilizarov frame or unilateral system) were evaluated. Docking site nonunion (17 patients), angular deformity or fracture of the lengthened area (8 patients) or intolerance of the external device (5 patients), in combination or not with a delayed distracted callus maturation, were the main reasons for this replacement.

Results: Average follow-up time was 4 (2–12 years). Average external fixation index was 40 days/cm of distraction. Intramedullary infection afterwards the placement of the nail was presented in one case (3,03%), and slight callus length loss in 5 cases (15,2%). Failure of union at the docking site with nail breakage was happened in 1 case (3,03%). In the other patients, ossification was achieved in the lengthened callus area as well as at the docking site, in an average time of 5,9 months from the moment of the nail insertion. All the patients were satisfied after the abstraction of the external devise, while their joint mobility and functionalism were improved rapidly.

Conclusions: The use of intramedullary nailing during consolidation phase after callus distraction, is a treatment option for delayed callus maturation or docking site nonunion, reducing the prolonged use of the external fixator.

Aim of the study

End results analysis of operative treatment in transcaphoid perilunate dislocations.

Material and method

From 1/1/91 to 1/1/01 twenty transcaphoid perilunate dislocations were operative treated. Ligamentous lesions were repaired through a dorsal approach, either by directly suturing the ligaments (10cases), or by using mini Mitek anchors (8 cases). Simple approximation and stabilization with K-wires was performed in 2cases. Scaphoid fractures were treated by open reduction and internal osteosynthesis with Herbert screw (12 cases), cortical AO 2.0 screw (2cases) or K-wires (6 cases). The wrist remained immobilized in a slight flexed position with short arm plaster for 8 weeks. Physiotherapy was necessary for all patients to regain full range of motion. Clinical and radiological evaluation was possible for all patients. The end results were estimated according to Cooney’s evaluation system. Kinematics of the injured wrists was also tested by cineradiography in order to estimate the dynamic behaviour of the wrist. The Average follow-up time was 52 months (range 11–76).

Results

Twelve patients had excellent result, 4 good, 1 fair, and 3 poor. Fourteen out of 16 cases returned to their previous work. Additional operations were required in two patients: 1) four corner arthrodesis because of aseptic necrosis of the proximal pole of the scaphoid with arthritic changes, 2) Scaphoid reoperation because of non-union by Matti-Russe procedure. The later was found in cineradiography to present a painless rotational instability.

Conclusions

Transcaphoid perilunate dislocation has a very good response to early operative treatment. Dorsal ligament repair with mite mini anchors seems to be a reliable easy made method. Scaphoid fracture stabilization requires a stable compressive fixation. Herbert screw is ideal and can be safely placed from proximal to distal via the dorsal incision. Cineradiography is the best way to evaluate normal wrist kinematics.