Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions – a prospective study

Madhusudhan, T.; Ramesh, B.; Manjunath, K.; Shah, Harshad; Sundaresh, D.C.; Krishnappa, Nagesha C

doi:10.1186/1752-2897-2-6

Cited by 71 publications

(97 citation statements)

References 12 publications

(17 reference statements)

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“…The Ilizarov technique of distraction osteogenesis is a satisfactory method of dealing with bone loss or residual bony deformity. 6,7,9,15,[17][18][19][20] In our series, three of 22 regenerated segments deformed after removal of the external fixation, requiring a second procedure. The mean time in an Ilizarov frame was nine months, which is comparable with other series of similar patients.…”

Section: Discussionmentioning

confidence: 67%

Management of infected nonunion of the long bones by a multidisciplinary team

Bose

Kugan²,

Stubbs

et al. 2015

The Bone & Joint Journal

119

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Infected nonunion of a long bone continues to present difficulties in management. In addition to treating the infection, it is necessary to establish bony stability, encourage fracture union and reconstruct the soft-tissue envelope. We present a series of 67 infected nonunions of a long bone in 66 patients treated in a multidisciplinary unit. The operative treatment of patients suitable for limb salvage was performed as a single procedure. Antibiotic regimes were determined by the results of microbiological culture. At a mean follow-up of 52 months (22 to 97), 59 patients (88%) had an infection-free united fracture in a functioning limb. Seven others required amputation (three as primary treatment, three after late failure of limb salvage and one for recalcitrant pain after union). The initial operation achieved union in 54 (84%) of the salvaged limbs at a mean of nine months (three to 26), with recurrence of infection in 9%. Further surgery in those limbs that remained ununited increased the union rate to 62 (97%) of the 64 limbs treated by limb salvage at final follow-up. The use of internal fixation was associated with a higher risk of recurrent infection than external fixation.

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Section: Discussionmentioning

confidence: 67%

Management of infected nonunion of the long bones by a multidisciplinary team

Bose

Kugan²,

Stubbs

et al. 2015

The Bone & Joint Journal

119

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“…Good care of pin sites and aggressive management of superficial infections is essential to prevent deep infections and septic arthritis (associated with wires placed less than 1 cm from the subchondral bone). Insufficient pin care has been associated with higher incidence of pin tract complications [28]. Muscle contracture and joint stiffness are significant problems, especially seen in patients where fixator is applied for prolonged periods and in fractures near the joints [29].…”

Section: Discussionmentioning

confidence: 99%

Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures

Wani

Baba

Kangoo

et al. 2010

International Orthopaedics (SICOT)

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We evaluated the results of patients with Gustilo types II, IIIA and IIIB open tibial fractures managed early with the Ilizarov external fixator (IEF). Sixty patients (51 males, nine females; age range 20-62 years; mean age 32.8 years) with type II (11 patients), type IIIA (13) and type IIIB (36) tibial diaphyseal fractures underwent emergency debridement and minimal bone fixation (with external fixator), followed by definite fixation with the IEF after three to five days. Average duration of the hospital stay was 8.6 days. All fractures united with an average union time of 21.1 weeks (standard deviation [SD] 3.18) in type II, 21.7 weeks (SD 3.57) in IIIA and 24. 9 weeks (SD 5.14) in IIIB fractures. The difference between union time in type II and IIIA was not significant (p>0.05), but that between IIIA (and also type II) and IIIB was significant (p<0.05). The healing index in patients who underwent lengthening was 1.5 months/cm. The wounds in 27 patients were managed by delayed primary closure, in 19 patients with second intent (all IIIB), in 11 patients with skin grafting (mostly type IIIB fractures) and in three patients with musculocutaneous flaps. The most common complications of the procedure were pin tract infection and pain at the fracture site. Most of the patients were able to achieve good knee and ankle range of motion.

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“…In Ilizarov group union was achieved in 13 out of 15 (86.7%) 20 patients. According to ASAMI criteria for bone results we had 8 excellent, 5 good, 0 fair and 2 poor results in Ilizarov group 20,26,27 and 9 excellent, 4 good, 1 fair and 1 poor results in Rail fixator 14,25 group. Functional results as per ASAMI criteria were 5 good, 1 fair and 2 poor in Ilizarov group compared to 6 good, 1 fair and 1 poor in rail fixator group including 7 excellent in both the groups.…”

Section: Chartmentioning

confidence: 94%

Comparison of Ilizarov and rail fixator in non union of long bones

2020

IJOS

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Introduction: Non-union of long bones is a challenging scenario to deal with as management of such fractures is difficult. Tibia is common site of non union.1 Various modes of treatment are available such as ultrasound, electrical stimulation, bone grafting and bone transport by illizarov and rail fixator. We have compared the role of Ilizarov and Rail fixator devices in our study of 15 patients each under both groups. Only Rail fixator had some more patient tolerance as compared to Ilizarov due to problems such as heavy apparatus. Materials and Methods: 15 patients of non union long bones in each group from 21 to 60 years with mean age of 37.6 year in group A and 40.5 years in group B. 90% of the patients were male. M ost of the patients had non union of tibia and further the middle one third was more commoly involved in either group. Nine out of 15 patients in both the groups had infected type of non-union. Average shortening was 2.9 cm in group A and 2.86 cm in group B. M aximum number of patients had undergone about two previous surgeries. 12 patients underwent acute docking or compression in group A compared to 13 in group B. Three and two patients underwent compression -distraction for treatment of non union in group A & B respectively. Patients were followed up at 6, 12 and 24 week intervals. Result: In our study union was seen in 13 cases in group A and 14 cases in group B. The duration for union was average 8.8 months and 8.1 months in respective groups. Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 80% of the cases in Group A and 86% of cases as per ASAM I scoring system. Conclusion: Bone results were more or less similar in both the groups. Functional results were a bit better in rail fixator group. Rate of complication were also similar in our study. However patients tolerated rail road with ease and application of rail fixator and comfortable distraction procedure had marginal benefit over Ilizarov.

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Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions – a prospective study

Cited by 71 publications

References 12 publications

Management of infected nonunion of the long bones by a multidisciplinary team

Management of infected nonunion of the long bones by a multidisciplinary team

Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures

Comparison of Ilizarov and rail fixator in non union of long bones

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