Pilon fracture is a severe injury which has a great impact on the patients' lives, but in what extend is not clear yet in the literature. The purpose of this study was to investigate the gait alternations after treatment of patients who had pilon fractures. We have evaluated the gait pattern of patients who were treated with circular Ilizarov frame following pilon fractures in our department. The gait was tested by using a force plate in a walking platform. Ground Reaction Forces (GRF) and timing of gait phases data were collected during level walking at self-selected speeds. The patients performed two walking tasks for each limb and the collected data were averaged for each limb. Demographic, clinical, radiological, trauma outcome (COST) and quality of life questionnaire (SF-12) data were also collected.Purpose
Materials & Methods
Humerus fracture non-union is a challenge for which a wide range of treatments exist. We present our experience of managing these by hybrid Ilizarov frame fixation, without bone graft or debridement of the non-union site. Case notes review of a consecutive series of 20 patients treated for aseptic humeral non-union between 2004 and 2016. Eighteen patients had previous plate or intramedullary nail fixations, and 2 had no prior surgery. During Ilizarov application, any existing metalwork preventing dynamisation of the fracture site was removed through minimal incisions before compression of the fracture site was then achieved. Only 3 patients had open debridement or osteotomy of the non-union site, otherwise all other patients had no debridement of their non-union.Background
Methods
Anatomical reduction of articular fragments in tibial plateau fractures often leads to a void and there is a need to fill dead space and support the articular fragment. MIIG X3 is marketed as high strength injectable graft, which resorbs and remodels fast. Efficacy and complications related to the use of this bone graft substitute were evaluated in this study Between January 2012 and December 2016 we injected calcium sulphate (MIIGX3) in 50 out of 126 consecutive complete articular (AO type C3) tibial plateau fractures that were stabilised with Ilizarov ring fixator. Postoperative CT scans after weight bearing and sequential radiographs were evaluated for union, graft resorption and subsidence. IOWA functional outcome score and complications were recorded.Introduction
Methods
Our unit has extensive experience with the use of Ilizarov circular frames for acute fracture and nonunion surgery. We have observed and analysed fracture healing patterns which question the role of relative stability in fracture healing and we offer limb mechanical axis restoration as a more important determinant. To assess for the presence of external callus, when only relative stability has been achieved but with anatomical restoration of the mechanical axis (ARMA).Introduction
Aim
The circular Ilizarov frame is a well-established method of external fixation used in the acute treatment of fractures. In our unit, based on our experience, we have changed practice from an all-wire construct to a hybrid, incorporating one 5mm titanium half-pin in the distal reference construct. We were able to compare the all-wire construct against this hybrid in terms of time to union and complications. All patients who underwent circular frame fixation between 2009 and 2016 for Schatzker IV-VI tibial plateau fractures at one district general hospital were included in the study. The date of union was noted and time to union was calculated.Background
Methods
Circular frames are used to treat a wide spectrum of acute injuries and deformities. We report on our experience of treating both acute and chronic trimalleolar fracture dislocations with a closed technique, utilizing fine wires and a circular frame. Data was collected from all patients treated for either acute or chronic trimalleolar fracture dislocations at a single centre between January 2016 and December 2017. A total of 10 patients were identified, 8 with acute injuries and 2 with chronic/delayed injuries. Clinical and radiological outcomes were recorded, as well as patient reported outcome measures (PROMs) using the Chertsey Outcome Score for Trauma (COST score).Aim
Methods
Tibia plateau fractures are severe knee injuries which have a great impact on the patients' lives, but in what extend is not clear yet in the literature. The purpose of this study was to investigate the gait alternations after treatment of patients who had severe tibia plateau fractures which were treated with circular ilizarov frame. We have evaluated the gait pattern of patients who were treated with circular Ilizarov frame after severe tibia plateau fractures (Schatzker IV-VI) in our department. The gait was tested by using a force plate in a walking platform. Ground Reaction Forces (GRF) data were collected during level walking at self-selected speeds. The patients performed two walking tasks for each limb and the collected data were averaged for each limb. Demographic, clinical, radiological and quality of life questionnaire (SF-12) data were also collected.Purpose
Materials & Methods
Patient Reported Outcome Measures (PROMs) are used as outcome of many surgical treatments such as Hip and knee joint replacements, varicose vein and groin hernia surgery. Outcome scores in orthopaedics tend to be site and/or pathology specific. Trauma related pathology uses a surrogate outcome scores. A unified outcome score for trauma is needed to help with the measurement of outcomes in trauma patients and evaluate the actual impact that trauma inflicts to patients' lives. We have designed a PROM especially for Trauma patients, in order to measure the extent of recovery to pre-injury state. This score uses as baseline the pre-injury status of the patient and has the aim to determine the percentage of rehabilitation after any form of treatment. This PROM is not site specific and can be used for every Trauma condition. It uses simple wording, user friendly and accessed via phone conversation. The outcome score consists of eleven questions. The first ten questions use the 5-point Likert scale and the final question a scale from zero to ten. The questions are divided into three subgroups (Symptoms, Function and Mental status). The final question assesses the extent of return to pre-injury status. The SF-12v2 questionnaire was used for the validation of the COST questionnaire. We gathered COST and SF-12v2 questionnaires from patients who were at the end of their follow-up after treatment for various trauma conditions, treated either conservatively either operatively.Introduction
Materials & Methods
This study aimed to determine the long-term functional,
clinical and radiological outcomes in patients with Schatzker IV
to VI fractures of the tibial plateau treated with an Ilizarov frame.
Clinical, functional and radiological assessment was carried out
at a minimum of one year post-operatively. A cohort of 105 patients
(62 men, 43 women) with a mean age of 49 years (15 to 87) and a
mean follow-up of 7.8 years (1 to 19) were reviewed. There were
18 type IV, 10 type V and 77 type VI fractures. All fractures united
with a mean time to union of 20.1 weeks (10.6 to 42.3). No patient
developed a deep infection. The median range of movement (ROM) of
the knee was 110o and the median Iowa score was 85. Our study demonstrates good long-term functional outcome with
no deep infection; spanning the knee had no detrimental effect on
the ROM or functional outcome. High-energy fractures of the tibial plateau may be treated effectively
with a fine wire Ilizarov fixator. Cite this article:
The Schatzker classification is applied in the management of tibial plateau fractures. The unique pattern of Schatzker VI fractures requires recognition for proper fixation. We have treated 33 patients with Schatzker IV tibial plateau fractures including non-unions and mal-unions. Patients had a temporary spanning Ilizarov frame with intraoperative distraction, articular reconstruction and olive wires for indirect reduction. No open surgery was performed. Patients mobilised fully weight-bearing and underwent post-operative CT scan and regular outpatient reviews. At six weeks the femoral ring was removed, and patients underwent a staged dynamisation protocol prior to frame removal.Background
Method:
Charcot arthropathy is a condition related to the loss of protective sensation of a joint. It normally presents in its early inflammatory phase, followed by bone destruction. Recognised treatment for this is total contact casting (TCC). However, in a small group this may be unsuccessful in preventing deformity progression. TCC can also be difficult in the presence of recalcitrant ulceration and deformed feet. 40 patients, with a diagnosis of Charcot foot, were followed from presentation in our unit over 3 years. An Ilizarov frame was used for two groups: those in the early phase who showed progressive deformity despite TCC (5 patients) and those with chronic ulceration (4 patients). Frames were modified to allow weight-bearing on the frame (with no foot contact). All other patents were treated with TCC.Background:
Method:
The aim of this study was to review the surgical complications and clinical outcomes of patients with Pilon fractures treated with Ilizarov frames. Data collected included surgical complications, grade of initial injury using the Ruedi-Allgower classification and quality of reduction according to the Teeny and Wiss criteria. Outcome scores were collected retrospectively using the Foot and Ankle Disability Index (FADI).Background:
Methods:
We compared the outcome of patients treated for an intertrochanteric fracture of the femoral neck with a locked, long intramedullary nail with those treated with a dynamic hip screw (DHS) in a prospective randomised study. Each patient who presented with an extra-capsular hip fracture was randomised to operative stabilisation with either a long intramedullary Holland nail or a DHS. We treated 92 patients with a Holland nail and 98 with a DHS. Pre-operative variables included the Mini Mental test score, patient mobility, fracture pattern and American Society of Anesthesiologists grading. Peri-operative variables were anaesthetic time, operating time, radiation time and blood loss. Post-operative variables were time to mobilising with a frame, wound infection, time to discharge, time to fracture union, and mortality. We found no significant difference in the pre-operative variables. The mean anaesthetic and operation times were shorter in the DHS group than in the Holland nail group (29.7 We conclude that the DHS can be implanted more quickly and with less exposure to radiation than the Holland nail. However, the resultant blood loss and need for transfusion is greater. The Holland nail allows patients to mobilise faster and to a greater extent. We have therefore adopted the Holland nail as our preferred method of treating intertrochanteric fractures of the hip.
Between 1993 and 2000 we treated 14 patients with nonunion of fractures of the distal humerus; 11 had already had previous fixation which had failed. The mean time to surgery was 21 months after injury. All the fractures were very low which made it difficult to obtain a firm hold of the small distal fragment. The problem of fixation was addressed by inserting a Coventry infant hip screw into the humeral condyles. The screw has a thread of wide diameter which gives excellent purchase on the small distal fragment. The condyles can then be compressed on to the humeral shaft using a 4.5 mm narrow tibial dynamic plate. Of these 14 difficult cases of nonunion, 12 progressed to union.
