Improved Ilizarov method for management of deformity and ulceration on foot and ankle of spina bifida

Background. Patients with advanced ankle arthrosis or joint deformities and co-existing lower limb shortening present a complex therapeutic problem. This paper presents the Ilizarov treatment as a comprehensive method of simultaneous ankle arthrodesis and equalisation of lower limb length in 18 patients. Material and methods. Eighteen patients with arthrosis, deformities or other conditions of the ankle joint and ipsilateral lower limb shortening were treated with the Ilizarov method. The patients were assessed with the Foot and Ankle Outcomes Questionnaire before the treatment and one year after Ilizarov Fixator removal. Results. The Ilizarov Fixator allows early weight-bearing of the operated limb, which is undoubtedly convenient for the patient. The mean treatment duration was 8.2 months (range 4-18 months). Lower limb lengthening was 4.1 cm on average (range 2.5-8.5 cm). Bone union was achieved in all cases. Radiological and clinical outcomes were satisfactory in all 18 cases. Prolonged regenerate calcification was recorded in 1 patient. Ten patients developed soft tissue pin-tract infections and in 1 patient the Kirschner wire broke. According to the Foot and Ankle Outcomes Questionnaire, patients achieved a notable improvement in daily functioning and quality of life. Conclusions. The outcomes of a comprehensive treatment consisting of ankle arthrodesis and lower-leg lengthening using the Ilizarov method confirm its effectiveness. The Ilizarov Fixator allows early weight-bearing of the operated limb and evaluation at all treatment stages, creating an optimal biological environment for bone healing. The patient recovers functionally to allow satisfactory and pain-free functioning as well as resumption of daily responsibilities. The low incidence of complications adds to the attractiveness of the method.

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Ilizarov method in treatment of neurological foot deformities

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-3-383-389 ◽

2021 ◽

Vol 27 (3) ◽

pp. 383-389

Author(s):

A. Kirienko ◽

◽

E. Malagoli ◽

G. Lucchesi ◽

◽

...

Keyword(s):

Spina Bifida ◽

Motor Neurons ◽

Foot Deformities ◽

Ilizarov Method ◽

Excellent Outcome ◽

Charcot Marie Tooth Disease ◽

Knee Contracture ◽

The Mean ◽

Time Required ◽

Mean Time

Introduction Diseases related to the lesions of upper or lower motor neurons, such as spina bifida, myopathy, and residual polio, often cause severe deformities of the foot and ankle. The treatment goal is to convert a deformed and rigid foot into a plantigrade foot. Matherial and method We treated 51 neurological feet from 2001 to 2018 with the Ilizarov method. They were polio outcomes in 27 cases, 17 feet were affected by spina bifida, 6 other patients had Charcot-Marie-Tooth disease. Results Results were assessed by comparing appearance and function before and after surgery described by Dimeglio, and modified by Dong Y.L. et al. Before surgery, there were 33 moderate and 28 severe deformities (average preoperative scores, 6.3). The mean time required to correct a deformity was 37.1 days (range, 22–58 days) and the mean time for stabilization was 67.2 days (range, 45–98 days). At latest follow-up (mean 7.42 years, from 13 month to 16 years), clinical outcomes and patient satisfaction were considered acceptable. 28 patients achieved an excellent outcome and 21 patients had a good outcome, two feet were classified as having a poor result. Nearly 86 % of patients (44 patients) were satisfied with their outcomes and replied they would repeat their procedure. Complications include infection in 15 % of K-wire tracts, Dysesthesia in 5 cases, superficial necrosis in 3. One patient developed knee contracture. 2 patients were re-operated with V osteotomy. Conclusions The Ilizarov method represents a great resource in the treatment of severe neurological deformities of the foot.

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Orthopaedic management of spina bifida—part II: foot and ankle deformities

Journal of Children s Orthopaedics ◽

10.1007/s11832-011-0368-9 ◽

2011 ◽

Vol 5 (6) ◽

pp. 403-414 ◽

Cited By ~ 29

Author(s):

Vineeta T. Swaroop ◽

Luciano Dias

Keyword(s):

Spina Bifida ◽

Foot And Ankle

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Closed arthrodesis in infected neuropathic ankles using Ilizarov ring fixation

The Bone & Joint Journal ◽

10.1302/0301-620x.102b4.bjj-2019-1158.r1 ◽

2020 ◽

Vol 102-B (4) ◽

pp. 470-477 ◽

Cited By ~ 2

Author(s):

Yaser Alammar ◽

Anatoliy Sudnitsyn ◽

Andrey Neretin ◽

Sergey Leonchuk ◽

Nikolay Mikhailovich Kliushin

Keyword(s):

Operating Time ◽

Deformity Correction ◽

Ankle Arthrodesis ◽

Ilizarov Method ◽

Foot And Ankle ◽

Ring Fixator ◽

Ilizarov Ring Fixator ◽

Group A ◽

American Orthopaedic ◽

Group B

Aims Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. Methods We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. Results The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. Conclusion We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470–477.

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