The Ilizarov Method of External Fixation: Current Intraoperative Concepts

Lee, Daniel K.; Duong, Elizabeth Thu Anh; Chang, Douglas G.

doi:10.1016/j.aorn.2009.11.064

Cited by 11 publications

(7 citation statements)

References 16 publications

(37 reference statements)

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“…Ilizarov fixator is an external fixation device used in the orthopedic surgical procedure to lengthen or correct the angular deformities in limb bones and to treat compound or open bone fractures and infected nonunion fractures. 1 The prevalence of nonunion in closed tibial fractures is 2.5% and it increases 5–7-fold for open fractures with gross contamination and extensive soft tissue damage. 2 The bone defect is filled by bone transport, as described by Ilizarov corticotomy and distraction technique that forms new bone at the trailing end, also known as distraction osteogenesis.…”

Section: Introductionmentioning

confidence: 99%

Treatment of complex nonunion of the shaft of the tibia using Ilizarov technique and its functional outcome

Sahu

Ranjan

2016

Niger Med J

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Background:A complex nonunion of the shaft of the tibia is a major cause of morbidity and mortality in patients with lower extremity injuries.Aims:The aim of this study was to evaluate the outcome of the functional and radiological outcome of complex nonunion shaft of tibia, treated by radical debridement, Ilizarov ring fixator with compression and distraction osteogenesis.Methods:From 2005 to 2010, sixty cases of complex nonunion shaft of tibia were included in our study. All infected nonunions were managed by radical debridement, fixed with Ilizarov ring fixator, monofocal/bifocal compression, and distraction osteogenesis. The average duration of follow-up is 36 months (26–50 months). The functional evaluation was done by using Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system and bone union with serial radiographs.Results:All patients had a successful union. The mean time for union was 7 months (5–9 months). The mean time of fixator removal is 12 months (8–14 months). Every patient had pin tract infections which were successfully treated with oral antibiotics. Four patients had an equinus deformity, one patient had insignificant limb shortening (1.5 cm), and three patients had soft tissue dystrophy. Using the ASAMI scoring system, we obtained 45 excellent, 10 good, 3 fair, and 2 poor functional results.Conclusions:The Ilizarov technique for complex nonunions has a high rate of success in achieving union and eradicating infection, bone loss, and malalignment. Radical debridement is the key step to control bone infection.

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Section: Introductionmentioning

confidence: 99%

Treatment of complex nonunion of the shaft of the tibia using Ilizarov technique and its functional outcome

Sahu

Ranjan

2016

Niger Med J

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“…The technique offers the advantage of simultaneously reconstructing both bone and soft-tissue defects with distraction, avoiding the procedure of flap. However, this technique also has the disadvantages of a long duration of regenerate consolidation and frame wearing, regenerated scarred soft tissues and frequent dressing change [29]. Paley et al [21] stated that bone transport beneath the flap seemed to proceed more easily than in closed defects with scarred soft tissues and flap coverage may contribute to docking site union without grafting.…”

Section: Bone Transport Combined With Soft-tissue Transport (Open Bonmentioning

confidence: 99%

Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

Fan

et al. 2021

BMC Musculoskelet Disord

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Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2–58 years). The mean defect of bone was 11.87 cm ± 2.78 cm (range, 8.2–18.2 cm) after radical resection performed by TFT. The soft tissue defects ranged from 7 cm × 8 cm to 24 cm × 12 cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12–96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7–147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14–37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

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“…The technique offers the advantage of simultaneously reconstructing both bone and soft-tissue defects with distraction, avoiding the procedure of ap. However, this technique also has the disadvantages of a long duration of regenerate consolidation and frame wearing, regenerated scarred soft tissues and frequent dressing change [27]. Paley et al [19] stated that bone transport beneath the ap seemed to proceed more easily than in closed defects with scarred soft tissues and ap coverage may contribute to docking site union without grafting.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of massive tibial bone and soft-tissue defects by trifocal bone transport combined with soft-tissue transport: experience from 31 cases

Fan

et al. 2020

Preprint

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Background The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion The TFT in concert with soft-tissue transport technique can be used successfully to manage large tibial bone and soft-tissue defects. Soft-tissue transport can offer a feasible method for the defects with good soft tissue coverage on the bone ends. However, imprecision in the series results precludes a definitive conclusion, and comparative study is needed to assess whether soft-tissue transport is more effective than flap transfer for such soft-tissue defect.

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The Ilizarov Method of External Fixation: Current Intraoperative Concepts

Cited by 11 publications

References 16 publications

Treatment of complex nonunion of the shaft of the tibia using Ilizarov technique and its functional outcome

Treatment of complex nonunion of the shaft of the tibia using Ilizarov technique and its functional outcome

Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

Reconstruction of massive tibial bone and soft-tissue defects by trifocal bone transport combined with soft-tissue transport: experience from 31 cases

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