Primary ilizarov external fixation in open grade III type C distal femur fractures: Our experience

Kumar, Rakesh; Mohapatra, Soumya Shrikanta; Joshi, Narendra; Goyal, Subhash; Kumar, Kamlesh; Gora, Rajendra

doi:10.1016/j.jcot.2019.01.026

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…Sixty articles met the inclusion criteria 3,17–75 (Table I). The included articles were from 37 different journals, had 58 different first authors, and were published between 1990 and 2022.…”

Section: Resultsmentioning

confidence: 99%

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

Wang,

Stockton,

Flury

et al. 2024

JBJS Reviews

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Background: Distal femur fractures are known to have challenging nonunion rates. Despite various available treatment methods aimed to improve union, optimal interventions are yet to be determined. Importantly, there remains no standard agreement on what defines radiographic union. Although various proposed criteria of defining radiographic union exist in the literature, there is no clear consensus on which criteria provide the most precise measurement. The use of inconsistent measures of fracture healing between studies can be problematic and limits their generalizability. Therefore, this systematic review aims to identify how fracture union is defined based on radiographic parameters for surgically treated distal femur fractures in current literature. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection databases were searched from inception to October 2022. Studies that addressed surgically treated distal femur fractures with reported radiographic union assessment were included. Outcomes extracted included radiographic definition of union; any testing of validity, reliability, or responsiveness; reported union rate; reported time to fracture union; and any functional outcomes correlated with radiographic union. Results: Sixty articles with 3,050 operatively treated distal femur fractures were included. Operative interventions included lateral locked plate (42 studies), intramedullary nail (15 studies), dynamic condylar screw or blade plate (7 studies), dual plate or plate and nail construct (5 studies), distal anterior-posterior/posterior-anterior screws (1 study), and external fixation with a circular frame (1 study). The range of mean follow-up time reported was 4.3 to 44 months. The most common definitions of fracture union included “bridging or callus formation across 3 of 4 cortices” in 26 (43%) studies, “bony bridging of cortices” in 21 (35%) studies, and “complete bridging of cortices” in 9 (15%) studies. Two studies included additional assessment of radiographic union using the Radiographic Union Scale in Tibial fracture (RUST) or modified Radiographic Union Scale in Tibial fracture (mRUST) scores. One study included description of validity, and the other study included reliability testing. The reported mean union rate of distal femur fractures was 89% (range 58%-100%). The mean time to fracture union was documented in 49 studies and found to be 18 weeks (range 12-36 weeks) in 2,441 cases. No studies reported correlations between functional outcomes and radiographic parameters. Conclusion: The current literature evaluating surgically treated distal femur fractures lacks consistent definition of radiographic fracture union, and the appropriate time point to make this judgement is unclear. To advance surgical optimization, it is necessary that future research uses validated, reliable, and continuous measures of radiographic bone healing and correlation with functional outcomes. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

Wang,

Stockton,

Flury

et al. 2024

JBJS Reviews

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“…In recent years, more evidences have reported that patients with open fractures and bone defects were treated with 1-staged Ilizarov external fixation. [ 9 , 10 ] For emergency patients, although Ilizarov technique is more stable than temporary external fixator, the installation time of fixator was too long and it needs repeated fluoroscopy to adjust the limb force line. Therefore, Ilizarov technique seems not suitable for emergency surgery for emergency patients with severe injury.…”

Section: Discussionmentioning

confidence: 99%

Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report

Gao

Ding

et al. 2022

Medicine

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Rationale: To evaluate the clinical effects of 1-stage revascularization, vacuum sealing drainage covering the wound, temporary external fixation and 2-stage Ilizarov bone transport for the treatment limb destruction injury.Patient concerns and diagnosis: Nine patients with limb destruction injury between September 2014 and June 2019 at our institute were evaluated retrospectively. The age of patient was 21 to 51 years with an average of 33 years. The injuries were caused by vehicle accidents in 4 patients, gunshot in 1 patient, and crushing injuries in 4 patients. All of them had vascular injury. The average length of bone defect was 9.5 (8.3-10) cm. Regular follow-up was performed on wound healing, bone transport time, bone healing time, external fixation index, and limb function.Interventions: All patients underwent 1-stage revascularization and temporary external fixation during emergency surgery, and then gradual bone transport by Ilizarov fixator was performed until the broken fracture site was reunited.Outcomes: Nine patients were followed up for 12 to 48 months (average 30 months). Six patients were treated with autogenous cancellous bone graft for the second time, and 2 patients healed spontaneously. The mean wound healing time was 86 (73-90) days. The bone transport time was 97 (88.3-105.3) days, and the bone mineralization time was 164.5 (156.8-181.3) days, and the healing time of the docking sites was 6.8 (6.1-8.3) months. The external fixator time was 14.5 (12.5-17) months with the external fixation index was 1.5 (1.4-1.8) m/cm. At the last follow-up, according to the Association for the Study of the Method of Ilizarov functional scores, excellent functional outcomes were obtained in 5 patients, good in 1 patients, moderate in 2 patients. According to the Association for the Study of the Method of Ilizarov Radiological System, excellent functional outcomes were obtained in 6 cases and good in 2 cases.Lessons: One-stage revascularization and temporary external fixation combined with 2-stage Ilizarov bone transport technique for the treatment of bone defects in limb destruction injury have satisfactory clinical effects and few complications, and can be applied under the condition of strict understanding of surgical indications.Abbreviations: ASAMI = Association for the Study of the Method of Ilizarov, VSD = vacuum sealing drainage.

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“…The consolidation phase may be 3 to 4 times longer than the distraction phase, which may increase the incidence of complications and make the patient eager to have the external fixator removed. 6 In addition, the use of Ilizarov external fixator can be psychologically stressful and creates sleeping problems because of its long duration and many other complications. Yiildiz et al 7 has reported that there was at least 1 psychiatric symptom in 52.5% of the individuals treated with a circular external fixator in his study.…”

Section: Discussionmentioning

confidence: 99%

The Old Supracondylar Fracture of Femur Treated by Gradual Deformity Correction Using the Ilizarov Technique Followed by the Second-Stage Internal Fixation in an Elderly Patient With Osteoporosis

Hou

Zhang

Bai

et al. 2020

Geriatr Orthop Surg Rehabil

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Background: The supracondylar nonunion of femur in elderly individuals is rare and challenging to manage. Nothing in English literatures or guidelines is available regarding this particular fracture characterized by osteoporosis, soft-tissue contracture, shortening, and joint stiffness. We report a case of an elderly patient with a supracondylar nonunion of the femur, which was successfully treated using staged Ilizarov techniques and dual plating. Case Presentation: An 84-year-old female patient was admitted to our orthopedic department for her pain and soft-tissue swelling around the right knee with claudication and shortening deformity of the affected extremity. She denied any specific history of trauma and had sought traditional Chinese medical attention for 6 months before she presented to our hospital. Diagnosis of the right femoral supracondylar nonunion was made based on the X-ray and computed tomography. Ilizarov external fixator was carried out for successive and slow distraction and gradual correction of the shortening deformity, in consideration of the nonunion was still present. Subsequently, internal fixation with dual plating of the distal femur was performed. Excellent function and patient satisfaction were observed at 6 months of follow-up. Conclusion: The protocol of Ilizarov technique with subsequent internal fixation of dual plating seems to be an efficient solution to the supracondylar nonunion of femur in elderly patients with osteoporosis. The advantage of the protocol is that it allows knee joint motion, avoids neurovascular complications, and gentle correction of soft-tissue contractures.

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Primary ilizarov external fixation in open grade III type C distal femur fractures: Our experience

Cited by 9 publications

References 22 publications

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report

The Old Supracondylar Fracture of Femur Treated by Gradual Deformity Correction Using the Ilizarov Technique Followed by the Second-Stage Internal Fixation in an Elderly Patient With Osteoporosis

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