Ilizarov Ring Fixation and Fibular Strut Grafting for C3 Distal Femoral Fractures

Ramesh, L J; Rajkumar, S.; Rajendra, R; Rajagopal, H P; Phaneesha, M S; Gaurav, Sahu

doi:10.1177/230949900401200117

Cited by 24 publications

(20 citation statements)

References 18 publications

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“…18 Current studies report good and satisfactory results with primary application of the Ilizarov external fixator for severely comminuted and open fractures of the distal femur with extensive soft-tissue injury. 12,19,20 The use of the Ilizarov external device for definitive fixation of fractures of the distal femur is the safest and most effective method since it provides adequate fixation and stabilisation at the site of the fracture, thus increasing osseous healing and decreasing infection. 12,19,20 In the presence of infection aggressive debridement has been shown to be the cornerstone of successful treatment.…”

Section: Discussionmentioning

confidence: 99%

“…12,19,20 The use of the Ilizarov external device for definitive fixation of fractures of the distal femur is the safest and most effective method since it provides adequate fixation and stabilisation at the site of the fracture, thus increasing osseous healing and decreasing infection. 12,19,20 In the presence of infection aggressive debridement has been shown to be the cornerstone of successful treatment. 21 In our series the use of the Ilizarov method offered limb salvage with no need for arthrodesis or amputation.…”

Section: Discussionmentioning

confidence: 99%

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The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss

Saridis

Panagiotopoulos

Tyllianakis

et al. 2006

The Journal of Bone and Joint Surgery. British volume

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We reviewed 13 patients with infected nonunion of the distal femur and bone loss, who had been treated by radical surgical debridement and the application of an Ilizarov external fixator. All had severely restricted movement of the knee and a mean of 3.1 previous operations. The mean length of the bony defect was 8.3 cm and no patient was able to bear weight. The mean external fixation time was 309.8 days. According to Paley's grading system, eight patients had an excellent clinical and radiological result and seven excellent and good functional results. Bony union, the ability to bear weight fully, and resolution of the infection were achieved in all the patients. The external fixation time was increased when the definitive treatment started six months or more after the initial trauma, the patient had been subjected to more than four previous operations and the initial operation had been open reduction and internal fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss

Saridis

Panagiotopoulos

Tyllianakis

et al. 2006

The Journal of Bone and Joint Surgery. British volume

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“…The Ilizarov system has proven successful for the treatment of complicated fractures and limblengthening procedures (Marsh et al 1997, Arazi et al 2001, Ramesh et al 2004, Nikonovas et al 2005, Sardis et al 2006.…”

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confidence: 99%

Rapid pre-tension loss in the Ilizarov external fixator: An in vitro study

Aquarius

Kampen²

2007

Acta Orthopaedica

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Background and purpose Wire pre-tension in the Ilizarov frame is considered to be important in order to reduce movements that can impair fracture healing. Wires will eventually lose part of their pre-tension, however. In order to gain more insight into the need for wire pre-tension, we investigated: (1) the amount of pre-tension loss, (2) the relationship between pre-tension loss and bolt-tightening torque, (3) the cause of a possible loss of pre-tension, and (4) the effect of pre-tension on cyclic micromotions and total displacement of the bone segments.Methods 3 Ilizarov configurations, with various wire pre-tensions and bolt-tightening torques, were tested 3 times with an MTS machine. For each wire, slippage and tensions were measured for the duration of the whole experiment.Results A loss of wire pre-tension (up to 75%) due to slippage was found. Higher bolt-tightening torques significantly reduced the amount of pre-tension loss. Furthermore, a higher wire pre-tension reduced the maximal axial displacement of the bone fragment. There was, however, least cyclic axial micromotion when no wire pre-tension was present-probably due to the lack of wire recoil.Interpretation Wires in an experimental Ilizarov external fixator lose pre-tension within a limited period of time, and probably also in the clinical setting. This does not seem to lead to increased cyclic axial micromotions of the bone fragements. However, the question remains as to how excessive axial displacement of the bone fragment and other loading configurations will affect the process of fracture healing in a patient.

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“…4 The use of a fibular strut and corticocancellous graft helped to bridge the fragments with severe comminution, maintain limb length and counteract the relatively unstable distal femoral block from varus/valgus collapse. Expertise in Ilizarov application and patient acceptance are major drawbacks of this method.…”

Section: Resultsmentioning

confidence: 99%

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

et al. 2017

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Background: Distal femur fractures are high velocity injuries which accounts for 7-10% of all femoral fractures. These injuries are complex injuries which are difficult to manage. Despite advances in techniques and implants, treatment remains a challenge, in many situations.Methods: We present a retrospective review of 8 cases, involved in high velocity road traffic accident who presented to emergency department at St. John’s Medical College, Bangalore, Karnataka, India between September 2011 to December 2015, with complex open fracture of the distal femur with bone loss. All were managed with initial wound debridement and skeletal traction. Subsequently fractured femur was reconstructed with distal femoral locking plate stabilization, along with autogenous non vascularised fibular graft and cortical-cancellous graft bridging the bone defect. Radiological union, functional outcome measured with Tegner and Lyslom scores, KOOS score and complications were assessed.Results: At average 5 years follow up, all the fractures have united well, with good functional outcome. X-ray showing united fracture with incorporation of the fibular graft. According to Tegner and Lyslom scoring, 6 patients had good rating, 2 had satisfactory rating. Average KOOS score was 82.15. Shortening of 2 cm and 4 cm in couple of patients was the major complication. Conclusions: Delayed primary surgery, using autologous non vascularised free fibular graft in conjunction with a locking compression plate, with autogenous cortico-cancellous graft is an effective, less technically demanding and cost effective means of reconstruction option to manage bone defects in complex open fractures of the distal femur. An overall acceptable results in terms of fracture union, fibular incorporation, adequate restoration of knee motion and early rehabilitation can be expected.

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Ilizarov Ring Fixation and Fibular Strut Grafting for C3 Distal Femoral Fractures

Abstract: Surgical repair with a fibular strut, cortico-cancellous bone graft and Ilizarov ring fixation appears a suitable treatment option for C3 distal femoral fractures.

Cited by 24 publications

References 18 publications

The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss

The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss

Rapid pre-tension loss in the Ilizarov external fixator: An in vitro study

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

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