Introduction: A gap non-union in various conditions has been treated successfully by the Ilizarov method. The gap can be filled up either by an acute shortening and re-lengthening (ASRL) procedure or by an internal bone transport (IBT). We compared the functional and clinical outcome of ASRL and IBT in gap non-unions of the infected tibia. Material and Methods: A retrospective study was conducted in our department from the data collected in the period between 1997 and 2010. There were 86 cases of infected non-union of the tibia, in patients of the age group 18 to 65 years, with a minimum two-year follow-up. Group A consisted of cases treated by ASRL (n=46), and Group B, of cases by IBT (n=40). The non-union following both open and closed fractures had been treated by plate osteosynthesis, intra-medullary nails and primary Ilizarov fixators. Radical debridement was done and fragments stabilised with ring fixators. The actual bone gap and limb length discrepancy were measured on the operating table after debridement. In ASRL acute docking was done for defects up to 3cm, and subacute docking for bigger gaps. Corticotomy was done once there was no infection and distraction started after a latency of seven days. Dynamisation was followed by the application of a patellar tendon bearing cast for one month after removal of the ring with the clinico-radiological union. Results: The bone loss was 3 to 8cm (4.77±1.43) in Group A and 3 to 9cm (5.31± 1.28) in Group B after thorough debridement. Bony union, eradication of infection and primary soft- tissue healing was 100%, 85% and 78% in Group A and 95%, 60%, 36% in Group B respectively. Nonunion at docking site, equinus deformity, false aneurysm, interposition of soft-tissue, transient nerve palsies were seen only in cases treated by IBT. Conclusion: IBT is an established method to manage gap non-union of the tibia. In our study, complications were significantly higher in cases where IBT was employed. We, therefore, recommend ASRL with an established protocol for better results in terms of significantly less lengthening index, eradication of infection, and primary soft tissue healing. ASRL is a useful method to bridge the bone gap by making soft tissue and bone reconstruction easier, eliminating the disadvantages of IBT.
Background: Peroneal nerve impalement is a recognized complication of percutaneous placement of fibular transfixation wires by palpatory method after increase use of ilizarov technique in treatment of Tibial fractures, deformity correction and limb lengthening. The purpose of this study was to identify the relationship between the Common Peroneal Nerve (CPN) and the palpable landmark, fibular head for insertion of proximal fibular transfixation wire, safe zones in proximal tibia and percentage of fibula where nerve crosses the neck. Methods: Standard 1.8-mm Ilizarov k-wires were inserted in the fibula head of fresh 10 un-embalmed cadaveric knees. Wires were inserted percutaneously to the fibula head by palpatory technique. The course of common peroneal nerve was dissected. Distances from wire entry point to the course of the common peroneal nerve were measured post-wire insertion. Results: The mean distance of the common peroneal nerve from the anterior aspect of the broadest point of the fibular head was 25.10 AE 4.39 mm (range 16-35 mm). Common peroneal nerve was seen to cross the neck of fibula at a mean distance of 32.3 AE 8.53 mm (range 20-50 mm). Wire placement was found to be on average, 46% of the maximal AP diameter of the fibula head and 44% of the distance from tip of fibula to the point of nerve crossing fibula neck. Conclusion: We recommend Proximal fibula transfixation wires are safer to pass with in 2 cm from the tip of the styloid process of the fibula, Anterior half of the head of fibula, <8% of total fibular length, Ventral half of the anterior compartment to avoid injury to peroneal fan. The palpable landmark of fibula is a misinterpretation; it is just the prominent subcutaneous portion of fibula and not the styloid process of fibula which on dissection was located much posterior. Better to take fluoroscopic guidance in difficult cases where palpation of head of fibula is difficult.
Background: Distal femur fractures account for less than 1% of all fractures and 4%-6% of all femur fractures. Soft tissue damage, comminution and articular extension makes the treatment difficult and they often result in unsatisfactory outcome and poor knee function. Open fractures further complicate the situation. In our study we compared functional outcome, time of union and complications of open complex distal femoral fractures treated with delayed plating or primary Ilizarov ring fixator. Material and Methods: we retrospectively reviewed 23 cases presented at department of Orthopedics, from January 2011 to January 2017. All skeletally mature patients with AO type C distal femur fractures and up to Gustilo Anderson grade IIIA were included. Pathological fractures, types IIIB and IIIC open fractures and patients with other fractures in the ipsilateral limb were excluded from the study. Patients in group A were treated with delayed plating and in group B with primary Ilizarov. Result: Out of the 23 cases, all cases in both groups showed radiological union between 16-22 weeks. 3 cases of group A showed shortening of >2 cm while Ilizarov group had none. In 5 cases of group A, primary bone grafting done during surgery having severe comminution (C3 type) and in one case secondary bone grafting done after 5 months for delayed union. Out of 12 cases of group A, 5 patients (42%) achieved full flexion. In group B limited knee flexion was seen in all cases with mean flexion at final follow-up of 92°. Conclusion: Delayed fixation with autologous fibular grafting and distal femoral locking plate provides adequate restoration of knee motion and early knee mobilization with high risk of infection. Whereas Ilizarov fixator shows better outcome in terms of infection control, LLD management, lesser number of surgeries, lesser hospital stay, earlier post-op rehabilitation and acceptable knee function.
BACKGROUNDDisplaced bicondylar tibial platue fractures (Schatzker V and VI) are otherwise known as high grade Schatzker type tibial platue fractures. They are always associated with soft tissue injury which possess a challenge for orthopaedic surgeons due to higher rate of post-operative infections, skin necrosis and wound dehiscence. Circular external fixator is a good option. However, delayed ORIF reduces the chance of infection & maintains articular congruity resulting in better functional outcome.
Background: GCT's are aggressive benign but potentially malignant lesions of bone.50% of these tumors involve knee joint. Wide resection and gap reconstruction by various methods are used for aggressive GCT's around knee joint. In this study we tried to evaluate the outcome of resection arthrodesis of knee by primary Ilizarov procedure. Materials and Methods: 20 patients with mean age of 30.5 years with campanacci grade III GCT around knee joint treated by resection arthrodesis and primary Ilizarov techniques between 2010-2015 were evaluated in this retrospective study. There were 8 males and 12 females. Mean follow up was 36 months (30-42 months range). Functional evaluation was done with musculoskeletal tumor society scale. Results: At the final follow up the functional score ranged from 26.4 out of 35. The average duration in fixator was 16 months and the mean regenerate achieved was 10.8 cm at final follow up Average duration to union was 6 months. All patients were ambulatory. There were no requirements for bone grafting in all 20 cases. 3 cases had nonunion at docking site one because of local recurrence and one case because of infection. Conclusion:Resection Arthrodesis with Ilizarov is a viable alternative and provides a long-lasting and cost-effective reconstruction for average patients in developing countries.
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