Outcome of complex non-unions of femoral fractures managed with Ilizarov method of distraction osteogenesis

Abstract

Objective: To evaluate the management outcome of complex non-union of femoral fractures with Ilizarov method in terms of bone union, functional results and any complications.
 Methods: This case series study was carried out at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Civil hospital, Quetta over a period of three and half years, January 1, 2015 to June 30,2018.
 Results: There were 50 patients in the study. There were 48(96%) males and 2(4%) females. The ages ranged between 17-54 years with a mean of 33.58±8.9 years. As per ASAMI criteria, the bone results were excellent in 17(34%), good in 30(60%), fair in 1(2%) and poor in 2(4%) patients. The functional results were excellent in 15(30%), good in 24(48%), fair in 8(16%) and poor in 3(6%). The bone union rate was 98% whereas infection eradication rate was 94%. The most frequent complications were pin tract infection affecting 80% patients, knee stiffness 60% patients and K-wires loosening 20% patients.
 Conclusion: The Ilizarov method provides an effective solution to address the complex non-union of femur fractures. It helps to ensure fracture healing, eradicates infection and provides good functional outcome. The attended complications are mild to moderate and manageable with conservative means.
 doi: https://doi.org/10.12669/pjms.35.4.244
 How to cite this:Bakhsh K, Zimri FK, Atiq-Ur-Rehman, Mohammad E, Saaiq M. Outcome of complex non-unions of femoral fractures managed with Ilizarov method of distraction osteogenesis. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.244
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Presentation and outcome of femoral infected non-unions in children and adolescents

“…Our abovementioned observations in are in conformity with several previously published studies. 5 , 6 , 16 , 17…”

“…We defined the bone union as the presence of bridging trabeculae on three cortices, no pain on dynamization and the absent movement at the union site as confirmed on fluoroscopic examination. 5 , 6 Once the docking was achieved, compression was done (0.25 twice weekly until union was achieved or the patient experienced pain). Dynamization was performed once radiological union was appreciated at the fracture site along with consolidation of the regenerate.…”

“…The Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria to employed to document, the bone results and functional results. 5 …”

“…There are few reported local studies regarding the use of Ilizarov method for lower limb injuries among adults, however there is scarcity of such studies regarding childhood fracture non unions. 5 , 6 …”

Clinical outcomes of bone transport using rail fixator in the treatment of femoral nonunion or bone defect caused by infection

“…To further demonstrate the effectiveness of the Ilizarov method and provide a basis for the clinical treatment of femoral-infected nonunion, we conducted a systematic review of infected nonunion of the femur treated by the Ilizarov method. We searched the literature from Cochrane Library, EMBASE, PubMed, and other relevant English orthopedic journals between January 2000 and January 2020, and initial literature search provided 438 relevant records, and finally 12 studies and a total of 338 patients were included in the systematic review (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). We recorded mean age, mean bone defect length, mean follow-up time, external fixation time (EFT), external fixation index(EFI), bone union rate, bone results, functional results, complications per patient, and occurrence of related complications, and performed statistical analysis using weighted means based on the sample size in each study by SPSS 25.0.…”