To investigate a treatment algorithm of various Ilizarov methods in managing infected tibial non-union. A consecutive series of 76 patients with infected tibial non-union were treated with one of four Ilizarov protocols, consisting of; monofocal distraction (25 cases), monofocal compression (18), bifocal compression/distraction (16) and bone transport (17). Median duration of non-union was 10.5 months (range 2–546 months). All patients underwent at least one previous operation, 36 had associated limb deformity and 49 had non-viable non-unions. Twenty-six cases had a new muscle flap at the time of Ilizarov surgery and 24 others had pre-existing flaps.Aims
Patients and Methods
The Ilizarov method for non-union comprises a range of treatment protocols designed to generate tissue, correct deformity, eradicate infection and secure union. The choice of specific reconstruction method is difficult, but should depend on the biological and mechanical needs of the non-union. We present a prospective series of patients with non-union of the tibia managed using a treatment algorithm based on the Ilizarov method and the viability of the non-union. Forty-four patients (34 men and 10 women) were treated with 26 viable and 18 non-viable non-unions. Mean duration of non-union was 19 months (range 2-168). 25 patients had associated limb deformity and 37 cases were infected. 42 patients had undergone at least one previous operation. Bone resection was dictated by the presence of non-viable and infected tissue. Four Ilizarov protocols were used (monofocal distraction in 18 cases, monofocal compression in 11 cases, bifocal compression-distraction in 10 cases and 5 bone transports) depending on the stiffness of the non-union or the presence of segmental defect.Introduction
Patients and methods
Ankle fusion presents a difficult problem in the presence of infection, inadequate soft tissue, poor bone stock and deformity. Nonunion and infection remains a problem even with internal fixation. Ilizarov frame provides an elegant solution to the problem with stable remote fixation while allowing lengthening, deformity correction and weight bearing. Twenty-one consecutive patients were studied. The mean age at onset of disease was 52 years (range 4-70). Mean duration of the problem was 59.9 months (6-372). Aetiology included traumatic arthritis in 5, traumatic arthritis with osteomyelitis in 1, failed ankle fusion in 8, septic arthritis in 1, infected ankle fracture nonunion in 1, avascular necrosis of talus in 1, congenital deformity in 3 and failed ankle arthroplasty in 1. 15 patients had deformity of the ankle at the time of presentation. 15 of the 21 patients had either clinical or radiological evidence of infection. Treatment principles involved local excision, deformity correction with good alignment and soft tissue management. Static Compression was achieved with an Ilizarov frame while dynamic fixation was performed in 3 cases for lengthening. Antibiotics treatment was continued until union in the infected cases. On achieving union the frame was removed and a below knee cast was applied for 4 weeks.Introduction
Patients and methods
Chronic osteomyelitis is a very difficult condition to treat. It presents a considerable challenge. A structured approach with a multidisciplinary team is important. Fifty-three patients with chronic femoral osteomyelitis were treated. Thirty-one cases followed fracture fixation, fourteen haematological, two knee fusion and two iatrogenic. Cierny and Mader grade was IV in twenty-eight cases(twelve non-unions). Union was achieved in eleven of twelve nonunions. 85% of cases were infection free with the current treatment. 92% union rate was achieved. Eradication of infection and functional preservation can be achieved by wide local debridement with good soft tissue coverage and skeletal stabilisation. Chronic osteomyelitis is a very difficult condition to treat. It presents a considerable challenge. A structured approach with a multi-disciplinary team is important. 85% of cases were infection free with the current treatment. 92% union rate was achieved. Eradication of infection and functional preservation can be achieved by wide local debridement with good soft tissue coverage and skeletal stabilisation. Fifty-three patients with chronic femoral osteomyelitis were treated. Mean age at onset was thirty-one years and mean duration of infection was one hundred and six months (range 2–504). Thirty-one cases followed fracture fixation, fourteen haematological, two- knee fusion and two iatrogenic. Cierny and Mader grade was IV in twenty-eight cases(twelve non-unions), III in twelve, II in two and I in eleven cases. Intramedullary disease was treated by reaming and cortical disease by local excision. Radical excision was done for local disease. Radical/segmental excision reserved for type IV disease. This was followed by dead space management (local antibiotics in thirty-eight patients), stabilization and iv antibiotics(four to six weeks). Infected nonunion was treated with excision and stabilization or Ilizarov reconstruction. Union was achieved in eleven of twelve nonunions. 85% of cases were infection free at a mean follow-up of thirty months (7–48).
We describe a technique of ‘cross-hip distraction’ to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.