Complications of use of the Ilizarov technique in the correction of limb deformities in children.

Velazquez, R; Bell, Deborah F.; Armstrong, Peter F.; Babyn, Paul; Tibshirani, Robert

doi:10.2106/00004623-199308000-00004

Cited by 152 publications

(76 citation statements)

References 13 publications

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“…No wonder that the clinical challenges of muscle distraction and subsequent decrease of adjacent joint range of motion go in parallel with the amount of lengthening. This is reflected by histological changes after lengthening of more than 30 % of its original length [22,[116][117][118][119], as the whole muscle from origin to insertion is stretched [81]. The elastic limit of stretched muscles (strength-strain curve) is 10-15 % of the length at rest.…”

Section: Effects Of Bone Lengthening On Surrounding Tissuesmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

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Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

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Section: Effects Of Bone Lengthening On Surrounding Tissuesmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

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“…The management of chronic osteomyelitis using the Ilizarov technique always needs time and effort from both the treating surgeon and the patient [13], which makes patient selection important [1]. Selection not only depends on the state of the osteomyelitis but also on the psychological condition of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Limb reconstruction using the Ilizarov technique has proven successful, but it is lengthy and the active cooperation of the patient is essential [4,13]. Many authors agree that a good blood supply and vascular bed are the keys to curing infection of bone [5].…”

Section: Introductionmentioning

confidence: 99%

Hemi-corticotomy in the management of chronic osteomyelitis of the tibia

Emara

2002

International Orthopaedics

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We reviewed 20 cases of chronic osteomyelitis of the tibial diaphysis without shortening or deformity resulting from different causes. Debridement included removal of the anterior half of the tibial cortex with any sequestrum, leaving the posterior cortex intact with its vascular muscle attachments. This was then followed by hemi-corticotomy (hemi-circumferential corticotomy and partial bone fragment transfer) in order to reconstruct the resulting defect. This technique proved effective in 19 out of the 20 patients. Follow-up was by plain radiography and sedimentation rate estimations, with an average follow-up of 34 months after operation. In nine patients, early removal of the fixation frame immediately after segment transfer followed by cast application produced the same outcome as achieved with patients in whom the frame remained in position until the end of the procedure.Résumé Nous avons revu 20 cas d'ostéomyélite chronique de la diaphyse tibiale résultant de causes différentes, sans raccourcissement ni déformation. Le débridement a inclus l'ablation de l'hémi corticale antérieure avec tous les séquestres, en conservant la corticale postérieure intacte avec ses insertions musculaires vascularisées. Cela a été suivi par une hémi-corticotomie (corticotomie hemicirconférentielle et transfert osseux partiel) pour reconstruire le déficit osseux. Cette technique s'est avérée efficace chez 19 des 20 malades. Le suivi a été fait par radiographies ordinaires et estimations de la vitesse de sé-dimentation, avec un délai moyen de 34 mois après l'opération. Chez 9 malades l'ablation précoce du fixateur immédiatement après le transfert du segment osseux, suivi par immobilisation plâtrée a conduit au même résultat que chez les malades ou le cadre est resté en position jusqu'à la fin du traitement.

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“…In a study published in 1990 by Paley et al found that patients will suffer from difficulty sleeping, contractures of the muscle and the soft tissues, subluxation and dislocation of the adjacent joints [12] . Moreover, a study published in 1993 by Velazquez et al found that paresthesia is a complication of Illizarov technique as well [13] . Plain X-rays and ultrasonography are often used to accurately measure the distraction gap and to check the consolidation of the bone [14] .…”

Section: Introductionmentioning

confidence: 99%

Indications and postoperative complications of tibial Illizarov’s technique in a tertiary care center, Saudi Arabia

Almalki¹,

Al-Tawayjri²,

Alamri³

et al. 2017

Int. J. Orthop. Sci.

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Background: Circular external fixation including Ilizarov method is a well-established technique often practiced in orthopedic surgery. The goal of this procedures is to lengthen extremity bones, reconstruct severely injured or fractured bone trauma, correct congenital bone deformities, treat infected bones and to treat pseudarthrosis. The importance of this study is that it will highlight the most common complications for this procedure in order to reverse them and have a better clinical outcome. The aim of this study is to assess the indications and postoperative complication rates following tibial circular external by Illizarov's method. Methods: We performed a consecutive case series, chart review study of 33 patients who were treated with the Ilizarov method, between 2010 and 2016. All patients who underwent tibial circular external fixators using Ilizarov method were selected for this study. There were 25 males and 8 females, mean age was 31.06 (range 14 -71). All data collected was coded in Excel sheet. SPSS package version 20 was used for data analysis. Results: The total number of subjects involved in this study was 33 subjects (Male: 25[75%]-Female: 8[25%]). The average age of the subjects was 31.06 (range 14 -71) with a standard deviation of +/-13.8. Overall, 63.6% of patients reported post-op complications. Whereas 36.3% of patients were free of complications. The main complication was pain which was reported in 15% of the subjects. Conclusion: There was a minimal complication rate associated with this technique in our institution compared to published studies. Several medical conditions were the indication for this procedure, primarily motor vehicle accidents deformities.

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Complications of use of the Ilizarov technique in the correction of limb deformities in children.

Cited by 152 publications

References 13 publications

Current concepts of leg lengthening

Current concepts of leg lengthening

Hemi-corticotomy in the management of chronic osteomyelitis of the tibia

Indications and postoperative complications of tibial Illizarov’s technique in a tertiary care center, Saudi Arabia

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