To describe our Ilizarov technique for the treatment of acquired equinus deformity in children and to determine if compliance with continuous use of an ankle foot orthosis (after removal of the fixator and until skeletal maturity) can influence the severity of recurrence. A cohort of 26 children with post-traumatic or post-burn contractures producing an equinus deformity was followed up for a minimum of 2 years after skeletal maturity. Cases with a bony deformity and/or nerve injury were excluded from this study. All patients were managed by a percutaneous tendo-Achilles lengthening followed by application of an Ilizarov external fixator. Post-operative treatment was in the form of gradual correction at a rate of 0.5 mm per day. Correction started from the second postoperative day until an over-correction of 15 degrees dorsiflexion was achieved. Ankle range of movement was encouraged 4 weeks prior to removal of the external fixator. On removal of the fixator, a posterior splint was applied until substituted by an ankle foot orthoses (AFO). The AFO was used continuously during the first 2-3 months and at nighttime thereafter until skeletal maturity. Fifteen children were compliant with the use of the AFO until skeletal maturity and 11 non-compliant. We compared the recurrence and the size of deformity between the two groups. The rate of recurrence, degree of equinus at recurrence and number of episodes of external fixation surgery showed statistical significant differences (P \ 0.01) between the groups. The Ilizarov technique for treatment of acquired equinus deformity secondary to soft tissue scarring is a safe and effective technique. The use of an AFO until skeletal maturity can decrease the risk and degree of recurrence.
AIM:To study the cost benefit of external fixation vs external fixation then nailing in treatment of bone infection by segment transfer. METHODS:Out of 71 patients with infected nonunion tibia treated between 2003 and 2006, 50 patients fitted the inclusion criteria (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups. RESULTS:The cost of hospital stay and surgery in the group of external fixation only was 22.6 ± 3.3 while the cost of hospital stay and surgery in the group of early external fixation removal and replacement by intramedullary nail was 26.0 ± 3.2. The difference was statistically significant regarding the cost of hospital stay and surgery in favor of the group of external fixation only. The total cost of medical care (surgery, hospital stay, treatment outside the hospital including medications, dressing, physical therapy, outpatient laboratory work, etc .) in group of external fixation only was 63.3 ± 15.1, and total absence from work was 38.6 ± 6.6 wk. While the group of early removal of external fixation and replacement by IM nail, total cost of medical care was 38.3 ± 6.4 and total absence from work or school was 22.7 ± 4.1. The difference was statistically significant regarding the total cost and absence from work in favor of the group of early removal and replacement by IM nail. CONCLUSION:Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance, and health authorities. Core tip: Fifty patients with infected nonunion tibia (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups. ORIGINAL ARTICLE Observational StudyEarly removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance and health authorities.Emara KM, Diab RA, Ghafar KAE. Cost of external fixation vs external fixation then nailing in bone infection.
Background: Adolescent tibia vara usually presents with genu varum deformity and is commonly associated with internal tibial torsion. The Ilizarov technique is one of the accepted techniques for correction of this deformity. Acute correction has the advantage of a shorter duration in the fixator and less patient discomfort. Using the Ilizarov construct with two rings decreases bulkiness of the frame and improves compliance. Methods: Thirteen male patients with adolescent Blount disease, seven of whom had bilateral deformities (total 20 knees), were managed by extra-focal tibial valgus lateral translation osteotomy with a low- profile Ilizarov frame fixation. The frame was removed after full union, and patients were followed-up for 18 mo. Patients were assessed clinically using intercondylar distance and radiographically by measuring the distal lateral femoral angle and proximal medial tibial angle on CT scanogram. Results: All patients achieved correction of the tibial varus deformity. The intercondylar distance improved from 12.1 cm on average preoperatively to 5 cm on average postoperatively. The mean preoperative deviation of the medial proximal tibial angle was 22 degrees while the mean postoperative deviation was 2.4 degrees (ranging from 0-8.5 degrees). The mean duration to union of the osteotomy was 9 wk (range, 7-10 wk). Pin track infection occurred in 8 limbs. Conclusions: Extra-focal percutaneous valgus lateral translation osteotomy and fixation with a low-profile Ilizarov frame allows accurate deformity correction, shorter duration in the fixator, and better patient comfort and satisfaction.
Background: Osteopetrosis is characterized by abnormally diminished osteoclast mediated skeletal resorption that leads to excessive accumulation of bone matrix, causing hard, dense bones with obliteration of the medullary canal, but with fragile, brittle bone. Osteopetrosis is endemic in North Sinai. The aim of the study was to assess the results of treatment of osteopetrotic subtrochanteric femoral fracture by open reduction and internal fixation using a locked plate combined with intramedullary reaming, describing the difficulties and the technical tips during fixation. Methods: Eight patients with osteopetrotic subtrochanteric femoral fractures (bilateral in two patients but not simultaneous) were treated. Osteosynthesis with internal fixation was performed using proximal femoral locked plates (in eight femora) or a dynamic hip screw (in two femora). Proper preoperative planning, presence of spare drill bits, patience during opening the medullary canal, and extra care with the sterilization rules are necessary. Delayed or nonunion and infection should be included in the informed consent. Results: No perioperative complications including infection, implant failure, or nonunion were observed during the follow-up period. All fractures healed at an average of 6.4 mo (6-8.4 mo) with no patients requiring bone grafting or additional procedures. All the patients were able to walk without pain and without assistance at the final follow-up. Conclusions: Management of osteopetrotic subtrochanteric femoral fractures by open reduction and internal fixation using locked plates combined with medullary canal reaming with extra care of the perioperative and intraoperative challenges and complications achieve successful results.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.