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

Saridis, Alkis; Panagiotopoulos, E.; Tyllianakis, Minos; Matzaroglou, Charalampos; Vandoros, N.; Lambiris, E.

doi:10.1302/0301-620x.88b2.16976

Cited by 78 publications

(54 citation statements)

References 20 publications

(25 reference statements)

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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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confidence: 99%

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

Aquarius

Kampen²

2007

Acta Orthopaedica

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“…It has several problems, like the fixator is cumbersome, visible externally, frequently associated with pin track infections. 4 The treatment protocol is long and painful. However, this can be reduced significantly by using light weight frames, and use of bicortical 6 mm tapered Schanz pins in the femoral diaphysis anchored to a single Italian arch instead of wires, which gives similar stability like fine wires sans painful pin track infections and keeps the fixator light weight and compact.…”

Section: Discussionmentioning

confidence: 99%

“…The fine wires are inserted by standard fashion. 4 Proximal tibia was fixed with a transcondylar K wire of 1.8 mm×400 mm, one medial facial wire and fibulotibial wire. The second ring was fixed with two wires only.…”

Section: Application Of Hybrid Ilizarov Framementioning

confidence: 99%

Management of infected supracondylar femoral nonunion with bone loss by primary knee arthrodesis with hybrid Ilizarov frame: a study of 10 cases

2017

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Background: Most of infected nonunion supracondylar femur with bone loss is a challenge to orthopedicians, where amputation is one of the choice. Opinions are divided on the appropriate management of infected nonunion supracondylar femur with bone loss. Evidence supports for both, osteosynthesis with or without salvaging knee joint and above knee amputation. Methods: 10 consecutive patients at Nizam's Institute of Medical Sciences, from Jan 2013 to December 2016, who underwent limb salvage with knee arthrodesis for infected nonunion supracondylar femur with bone loss were evaluated and followed till union. Treatment option in the form of osteosynthesis with knee arthrodesis was achieved with hybrid Ilizarov fine wire fixator. The hybrid Ilizarov frame comprised of conventional two ring tibial frame and one ring and one Italian arch in the femoral segment with half treaded pins, this construct was chosen because of less weight, less cumbersome without compromising the stability and basic features. Results: All patients went for solid knee arthrodesis in functional position, with a mean fusion time of 22.4 ± 4.97 weeks. The time interval between primary surgery and definitive treatment was 15.6 ± 6.37 weeks. The mean shortening of lower limb was 3.1±1.19 cms. To achieve arthrodesis quickly, it's necessary to have light weight, compact Ilizarov frame, have good bone to bone contact and allow early full weight bearing. Conclusions: Osteosynthesis with knee arthrodesis in cases of infected nonunion supracondylar femur with bone loss is a viable option in select cases where the patient is physiologically young, has undergone several procedures around the knee and the knee is stiff. Fusion of the knee enables quick restoration of the patient to his work place. Nagesh C et al. Int J Res Orthop. 2018 Jan;4(1):107-113 International Journal of Research in Orthopaedics | January-February 2018 | Vol 4 | Issue 1 Page 108 indication of knee arthrodesis today remains the infected non-salvageable prosthetic knee joint, which is not amenable to further reconstructive measures.2,3 The advantage of knee fusion in such post traumatic post infected non-unions enables the patient to ambulate quickly, gives painless stable knee with proprioceptive features.In cases of infected supracondylar femoral nonunions with bone loss, the main goal is to alleviate pain, eradicate the infection, achieve stability, and lead them for bony continuity. As the knee joint is the largest joint in the body, with lot of mobility, so, for fusion to occur it needs stability, vascularity and osteoinductive material. The issues here are infection, bone loss, instability and poor soft tissue envelope, unless these issues are identified and taken care the knee fusion will not occur. To address all these issues, Ilizarov frame appears to be savior. The greatest advantage of Ilizarov frame is it gives rotational stability, axial loading, and static and dynamic compression across the knee which is most essential for the fusion of the knee. The same may n...

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“…43 Radical debridement of infected bone followed by regeneration of lost bone length achieves the aim of maintaining limb length and eradication of infection with the frame providing mechanical stability and a means of applying mechanical stimulation (case Figure 7). 44,45 Treatment adjuncts in the management of skeletal non-union Various techniques are available to aid in the treatment of nonunion, the majority being aimed at biological stimulation. An overview is presented here but further information can be found in several review articles.…”

Section: Treatmentmentioning

confidence: 99%