Management of 30 infected nonunited tibial fractures by Ilizarov external fixator with acute shortening distraction technique with consideration of the causative organism

Abstract Background Peripheral nerve block is preferable for lower extremity surgery because it sufficiently blocks pain pathways at different levels providing excellent anaesthesia at the site of surgery. We designed this study to compare the efficacy and safety of SOFT block (sciatic-obturator-femoral technique) compared with spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. Methods One hundred and seven patients ASA I, II scheduled for fixation of open tibial fractures using Ilizarov external fixator. The patients were randomly allocated to receive either spinal anaesthesia or SOFT block. In spinal anaesthesia group, patients received spinal anaesthesia with hyperbaric bupivacaine 0.5% (7. 5-10mg). In SOFT group, patients received SOFT block with bupivacaine 0.25%. Primary endpoint included the duration of analgesia. The secondary endpoints included patient satisfaction scores, visual analogue scores, incidence of adverse events as vomiting, systemic toxicity from local anaesthetic drug and time to first effect of the techniques. Results The duration of SOFT block and time to first analgesic dose in SOFT group was significantly longer (p < 0.001). There was no significant difference between the study groups regarding satisfaction scores, the incidence of cardiovascular collapse, seizures and paraesthesia. Pain scores were significantly lower in SOFT group at 3,6,12 h postoperative (p < 0.001). The time to the first effect was significantly longer in SOFT group (p < 0.001). Conclusion SOFT is a feasible technique of local anaesthesia for control of postoperative pain with unremarkable adverse events compared with spinal anaesthesia, in patients undergoing fixation of tibial fractures using Ilizarov external fixator. Trial registration This trial was retrospectively registered at ClinicalTrials.gov. registry number: NCT03450798 on February 20, 2018.

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Treatment of Open Tibial Fractures with Ilizarov External Fixator

Orthopedics & Traumatology ◽

10.5035/nishiseisai.53.664 ◽

2004 ◽

Vol 53 (3) ◽

pp. 664-668

Author(s):

Takashi Miyamoto ◽

Noboru Yamamoto ◽

Yoshifumi Nagatani ◽

Kenji Miyahara ◽

Yoshiaki Makino

Keyword(s):

External Fixator ◽

Tibial Fractures ◽

Ilizarov External Fixator ◽

Open Tibial Fractures

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Ilizarov external fixator: acute shortening and lengthening versus bone transport in the management of tibial non-unions

Injury ◽

10.1016/j.injury.2004.10.027 ◽

2005 ◽

Vol 36 (5) ◽

pp. 662-668 ◽

Cited By ~ 48

Author(s):

J. Mahaluxmivala ◽

R. Nadarajah ◽

P.W. Allen ◽

R.A. Hill

Keyword(s):

External Fixator ◽

Bone Transport ◽

Ilizarov External Fixator ◽

Acute Shortening

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The Ilizarov external fixator - a useful alternative for the treatment of proximal tibial fractures A prospective observational study of 30 consecutive patients

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-14-11 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 19

Author(s):

Telmo Ramos ◽

Carl Ekholm ◽

Bengt I Eriksson ◽

Jón Karlsson ◽

Lars Nistor

Keyword(s):

Observational Study ◽

External Fixator ◽

Prospective Observational Study ◽

Tibial Fractures ◽

Ilizarov External Fixator ◽

Proximal Tibial Fractures

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A Prospective Observational Study on Efficacy of Ilizarov External Fixation in Infected Non-Union Tibial Fractures

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/181 ◽

2021 ◽

Vol 8 (15) ◽

pp. 932-938

Author(s):

Avinash Gundavarapu ◽

Vishal Singh ◽

Prashant Kumar Mishra ◽

Santhosh Kumar M

Keyword(s):

External Fixation ◽

External Fixator ◽

Functional Results ◽

High Energy ◽

Tibial Fractures ◽

Bony Union ◽

Ilizarov External Fixator ◽

Non Union ◽

Ring Fixator ◽

Study Results

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union

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Sciatic obturator femoral technique versus spinal anesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator: A randomised trial

10.21203/rs.2.15628/v2 ◽

2019 ◽

Author(s):

Hoda Shokri ◽

Amr Kasem

Keyword(s):

Adverse Events ◽

Nerve Block ◽

Spinal Anaesthesia ◽

External Fixator ◽

Randomised Trial ◽

Tibial Fractures ◽

Ilizarov External Fixator ◽

Open Tibial Fractures ◽

Significant Difference ◽

Analgesic Dose

Abstract Background Peripheral nerve block is an ideal choice for lower limb surgery because of the peripheral site of the surgical procedure and the ability to block pain pathways at multiple levels. The aim of this study was to assess the efficacy and safety of SOFT (sciatic-obturator-femoral nerve block technique) compared with spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixatorMethods This study was conducted over 107 patients ASA I, II scheduled for fixation of open tibial fractures using Ilizarov external fixator. The patients were randomly allocated to receive either spinal anaesthesia or SOFT block. In spinal anaesthesia group, patients received spinal anaesthesia with hyperbaric bupivacaine 0.5% (7.5-10mg). In SOFT group, patients received SOFT block with bupivacaine 0.25%. Primary endpoint included the duration of analgesia. The secondary endpoints included patient satisfaction scores, time of first analgesic dose, visual analogue scale scores, incidence of adverse events as vomiting, systemic toxicity from local anaesthetic, paresthesia observed within 48 hours of the block.Results The duration of soft block and time to first analgesic dose in SOFT group was significantly longer (p<0.001). The incidence of headache (p=0.028) and back pain (p=0.012) was significantly higher in spinal group. There was no significant difference between the study groups regarding satisfaction scores, the incidence of cardiovascular collapse, seizures and parathesia. Pain scores were significantly lower in SOFT group at 3,6,12 hours postoperative (p<0.001).Time to the first effect was significantly longer in SOFT (P<0.001).Conclusion Our results showed that SOFT is a feasible technique of local anaesthesia for control of postoperative pain with unremarkable adverse events compared with spinal anaesthesia, in patients undergoing elective fixation of tibial fractures using Ilizarov external fixator.

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