Evaluation of Results of Ilizarov Fixator and Methodology in Tibial Non- Union

Background: Treatment of non-union of tibial diaphyseal fractures has always posed a formidable challenge to surgeons. Persistant infection, deformity, bone loss, stiffness of joints and disability complicate the problem further. Ilizarov methodology tackles all the above problems simultaneously and offers a solution for non-union. Progressive new bone formation and increased vascularity following corticotomy and bone transport helps in filling bone gaps and promoting fracture union. Stability of the fixation allows early weight bearing, ambulation and joint mobilization. To evaluate the results of Ilizarov fixator in treating tibial non-union. Methods: This retrospective hospital study was conducted at Ramakrishna Mission Seva Pratishthan, Kolkata, India from August 2009 to February 2012. Forty two patients treated at this hospital between August 1994 and August 2011 with a minimum of 12 months follow up were included. The results were analysed on the outcome of bone and functional score using the Association for the Study and Applica-tion of the Method of Ilizarov (ASAMI) scoring system. Results: Of the 42 patients in this study, there were 28 (66.7%) excellent, 6 (14.3%) good, 5 (11.9%) fair and 3(7.1%) poor bone results and 17(40.5%) excellent, 20(47.6%) good, 2(4.8%) fair and 3(7.1%) poor functional results. Conclusions: Treatment of tibial non-unions with Ilizarov fixator is effective but not without considerable amount of complications and morbidity associated with it. The functional outcome was largely multifactorial and dependent on the final joint function, soft tissue condition and ability of the patient to return to activity.

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Managing Difficult Fractures due to Ballistic Trauma with Ilizarov Ring Fixation

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v9i1.3482 ◽

1970 ◽

Vol 9 (1) ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Pankaj Chand ◽

Roshan Lal Shrestha ◽

Bachu Ram KC ◽

Bhanu Chand Shah ◽

Amit Joshi ◽

...

Keyword(s):

Bone Loss ◽

Weight Bearing ◽

Joint Stiffness ◽

Valgus Deformity ◽

Bone Transport ◽

Healing Time ◽

Early Weight Bearing ◽

Non Union ◽

Ring Fixator ◽

Ilizarov Ring Fixator

20 fractures (7 femoral and 13 tibial) were treated with the illizarov apparatus between 2003 to 2006. Allwere old injuries, previously managed by internal fixation (intramedullary rods), external fixation (Hoffman'sexternal fixators), or conservatively with traction and plaster of paris slabs. Ilizarov fixators were appliedto manage infected non-union with or without bone loss and malunion. Corticotomy and bone transportwas carried out in cases with significant bone loss. In others without any limb shortening and minimalbony defect, bone grafting and compression was carried out. In one case valgus deformity along withnon-union was corrected. Early weight bearing with range of motion exercises for ankle and knee jointswere encouraged. Average fracture healing time was 12 months (8 to 18 months). All fractures healed with<5° of malalignment. Complications included pin site inflammation/ infection, muscle transfixation, kneeand ankle joint stiffness and a wire fracture. The ilizarov device provided definitive fixation with acceptableresults in all cases.Key words: Ilizarov ring fixator; distraction osteogenesis; bone transport; infective non-union;corticotomyDOI: 10.3126/mjsbh.v9i1.3482Medical Journal of Shree Birendra Hospital Vol.9(1) 2010 1-8

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APPROACH TOWARDS DEVELOPING AN ALGORITHM FOR GAP NONUNION

10.36106/ijsr/1425409 ◽

2020 ◽

pp. 1-6

Author(s):

Nirjhar Maji

Keyword(s):

Tertiary Care ◽

Functional Results ◽

Time Frame ◽

Activity Level ◽

Treatment Modalities ◽

Long Bone ◽

Care Hospital ◽

Non Union ◽

Formidable Challenge ◽

Back Ground

Back ground and objectives The treatment of Gap or Defect non-union presents a formidable challenge to Orthopaedic surgeons. Not only a union but also good functional outcome is the target of modern-day Orthopaedics. The objective of this study is to consider knowledge of all treatment modalities, time frame, and functional results of long bone defects and develop an algorithm. Summary The study is designed as retrospective, prospective observational study. It is conducted in tertiary care hospital (MIOT Hospitals, Chennai). Initial evaluation of all cases were done by Maurizio Catagni’s Classification. Type of surgeries, time spent in hospital, union time were calculated. Patients were followed up for a period of 1year. Patients with average defect size of 6.29cm on an average underwent 4.47 procedures and for an overall time of 17.8 weeks with around 83.80 % of individuals were able to return to their preinjury activity level. Analysis of all data was done and algorithm developed.

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Outcome of Ilizarov assisted ankle arthrodesis

International Surgery Journal ◽

10.18203/2349-2902.isj20180015 ◽

2018 ◽

Vol 5 (2) ◽

pp. 433

Author(s):

Priyajit Chattopadhyay ◽

Paras Kumar Banka ◽

Anindya Debnath ◽

Sanjay Kumar

Keyword(s):

Dynamic Compression ◽

Weight Bearing ◽

Major Complication ◽

Ankle Arthrodesis ◽

Time Interval ◽

Early Weight Bearing ◽

Ilizarov Fixator ◽

American Orthopaedic ◽

Second Procedure

Background: Among the various techniques used for ankle arthrodesis, Ilizarov technique has various advantages along with the potential for treating complex and failed cases.Methods: Eleven cases were undertaken for ankle arthrodesis using the Ilizarov fixator. Two rings were applied along the tibia and one at the talus/calcaneum. The articular cartilage was denuded, and dynamic compression applied. The clinical, functional and radiological outcome were evaluated. The goal was a stable fusion with a well aligned foot.Results: The mean follow-up period was 95 weeks. Fusion was achieved in all cases with no major complication. Only one case had a residual deformity. The average time interval for the ankle fusion was 140.8±25.7 days. The postoperative modified American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot score was 67.5±9.6 points.Conclusions: Ilizarov assisted ankle arthrodesis aids in early weight bearing, better alignment, and has good functional outcomes even in cases with previously failed procedures. It has the advantage of postoperative readjustment of the arthrodesis without the need of any second procedure with no major complications.

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Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171891 ◽

2017 ◽

Vol 3 (3) ◽

pp. 497

Author(s):

Vijaysing S. Chandele ◽

Abhishek P. Bhalotia ◽

Milind V. Ingle ◽

Maroti R. Koichade

Keyword(s):

Functional Outcome ◽

Tibial Plateau ◽

Weight Bearing ◽

Oxford Knee Score ◽

Tibial Plateau Fractures ◽

Knee Score ◽

Early Weight Bearing ◽

Non Union ◽

Approach Time

Background: Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to evaluate the functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach.Methods: Thirty two patients with tibial plateau fractures having posteromedial fracture alone or part of bicondylar fracture was operated with ORIF using Lobenhoffer approach. Time to union, maintenance of alignment, rate of complications and functional outcome was assessed using Oxford knee score.Results: The mean time to healing was 16.4 weeks, without any complication in the form of non-union and infection. Malunion with secondary loss of alignment was seen in only one case due to fracture comminution and early weight bearing. Oxford knee score was good to excellent in all the cases. Conclusions: With recent development in understanding these fractures, ORIF gives excellent to good outcome in all patients operated through Lobenhoffer approach. Long term disability can be prevented by maintenance of adequate alignment and reduction through direct visualization of fracture.

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TIBIAL-TALO-CALCANEUM ARTHRODESIS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.10.1727 ◽

2016 ◽

Vol 23 (10) ◽

pp. 1227-1231

Author(s):

Saeed Ahmad ◽

Mohammad Ikram ◽

Ashfaq Ahmed ◽

Amer Aziz ◽

Shahzad Javed ◽

...

Keyword(s):

Weight Bearing ◽

Intramedullary Fixation ◽

X Rays ◽

Radiological Outcome ◽

Early Weight Bearing ◽

Detailed History ◽

Non Union ◽

Case Period ◽

Clinical And Radiological Outcome ◽

Pain Improvement

Objectives: To determine the clinical and radiological outcome of Tibio-talocalcanealarthrodesis with Retrograde intramedullary SIGN Nail in patients with tibiotalar andsubtalar joint pathologies. Study Design: Descriptive case. Period: September 2012 to May2015. Setting: OPD or Emergency at Orthopaedics Unit of Ghurki Trust Teaching HospitalLahore. Materials and methods: 40 patients study. Detailed history, clinical examination andinvestigations were done after proper consent. Pre operative diagnosis was made on anteroposterior and lateral views of plan x rays. Retrograde Intramedullary fixation was done underimage control. All post operative patients were followed regularly on opd basis and outcomeof intramedullary fixation was determined on 6th post-operative month. Results: There were40 patients who underwent arthrodesis and fixation. There were 82.5% male and 22.5%female with mean age of 41.5 years. 95% of the patients having pain improvement whileonly 2.5% of the patients didn’t get benefit from it. Infection and non union were seen inonly 1 patient. Conclusion: retrograde sign nail is a good option for ankle and subtalar jointarthrodesis. Early weight bearing and healing in shorter period of time are its main advantages.

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Management of infected non-unions of long bones using limb reconstruction system (LRS) fixator

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170540 ◽

2017 ◽

Vol 3 (2) ◽

pp. 213 ◽

Cited By ~ 1

Author(s):

Satya Ranjan Patra ◽

Dasarath Kisan ◽

Divya Madharia ◽

Naresh Kumar Panigrahi ◽

Saswat Samant ◽

...

Keyword(s):

Weight Bearing ◽

Limb Lengthening ◽

High Energy ◽

Bone Transport ◽

Functional Score ◽

Infected Nonunion ◽

Limb Reconstruction ◽

Erroneous Decision ◽

Pin Tract Infection ◽

Flap Cover

Background: Due to increasing number of high-energy traumatic events, the incidence of complex and compound fractures are also in the rise. Such fractures are often exposed to various environmental contaminants, inadequate debridement and sometimes erroneous decision making leading to cases of infected nonunions. Eradication of infection in such cases and achieving union may sometimes pose serious challenge to orthopaedic surgeons. Presence of comminution, bone gap or deformity can seriously complicate the situation. No definite surgical technique has been found to be full proof in dealing with these infected nonunion cases. In this scenario the limb reconstruction system (LRS) fixator is emerging as a useful option for infected nonunions with deformity or gap nonunion.Methods: Twenty seven cases of infected nonunions involving tibia (n=19), femur (n=7) and humerus (n=1) were treated by LRS fixators after debridement of the infected nonunion site. Flap cover procedure was done as per necessity. Bone gaps and limb length discrepancies were dealt with bone transport or limb lengthening by the LRS instrument. Weight-bearing and removal of fixator was decided according to the radiological evidence of healing.Results: All the nonunions and the regeneration sites healed uneventfully, although the union time was varied (range, 21-52 weeks). Commonest complication was pin-tract infection and pain. The mean lower extremity functional score (LEFS) was 60.3 out of 80. Conclusions: LRS fixator is an excellent tool for management of infected nonunions which is easy to apply, comfortable for the patient with minimum complications and predictable as well as reproducible outcomes.

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Analysis of bone transport for ankle arthrodesis as a limb salvage procedure for the treatment of septic pilon fracture nonunion

Scientific Reports ◽

10.1038/s41598-021-04187-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Thomas Rosteius ◽

Sebastian Lotzien ◽

Matthias Königshausen ◽

Valentin Rausch ◽

Charlotte Cibura ◽

...

Keyword(s):

Soft Tissue ◽

Limb Salvage ◽

Ankle Joint ◽

Functional Results ◽

Ankle Arthrodesis ◽

Bone Transport ◽

Functional Score ◽

Salvage Procedure ◽

Pilon Fracture ◽

Additional Surgery

AbstractSeptic nonunion of the pilon region with ankle joint infection is challenging for orthopedic surgeons to treat and is associated with a high risk of limb loss. Therefore, the aim of this study was to evaluate the effectiveness of bone transport for ankle arthrodesis in salvaging the limp after septic ankle destruction of the pilon region. We conducted a single-center, retrospective study including 21 patients treated for septic pilon nonunion with accompanying septic ankle destruction via Ilizarov bone transport between 2004 and 2018. In all cases, the complete excision of the nonunion and the resection of the ankle joint were carried out, followed by treating the bone and joint defect with a bone transport into the ankle arthrodesis. In 12/21 patients an additional flap transfer was required due to an accompanying soft tissue lesion. The overall healing and failure rate, final alignment and complications were recorded by the patients’ medical files. The bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system and a modified American Orthopedic Foot and Ankle Society (AOFAS) scale. After a mean follow-up of 30.9 ± 15.7 months (range 12–63 months), complete bone and soft tissue healing occurred in 18/21 patients (85.7%). The patients had excellent (5), good (7), fair (4), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 6 patients had excellent, 7 good, and 6 fair results. The modified AOFAS score reached 60.6 ± 18 points (range, 29–86). In total, 33 minor complications and 28 major complications occurred during the study period. In 2 cases, a proximal lower leg amputation was performed due to a persistent infection and free flap necrosis with a large soft tissue defect, whereas in one case, persistent nonunion on the docking side was treated with a carbon orthosis because the patient refused to undergo an additional surgery. Bone transport for ankle arthrodesis offers the possibility of limb salvage after septic ankle destruction of the pilon region, with acceptable bony and functional results. However, a high number of complications and surgical revisions are associated with the treatment of this severe complication after pilon fracture.

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Ankle Arthrodesis with Simultaneous Lengthening of the Lower Limb Using the Ilizarov Fixator

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0012.8393 ◽

2018 ◽

Vol 20 (6) ◽

pp. 441-450

Author(s):

Karol Mochocki ◽

Radosław Górski ◽

Sławomir Żarek ◽

Łukasz Szelerski ◽

Paweł Małdyk

Keyword(s):

Lower Limb ◽

Weight Bearing ◽

Kirschner Wire ◽

Ankle Arthrodesis ◽

Ilizarov Method ◽

Comprehensive Treatment ◽

Foot And Ankle ◽

Early Weight Bearing ◽

Ilizarov Fixator ◽

Tract Infections

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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Presentation and management outcome of tibial infected non‑union with Ilizarov technique

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.67 ◽

2019 ◽

Vol 35 (1) ◽

Author(s):

Karim Bakhsh ◽

Atiq-Ur- Rehman ◽

Faridullah Khan Zimri ◽

Eid Mohammad ◽

Wazir Ahmed ◽

...

Keyword(s):

External Fixation ◽

Case Series ◽

Functional Results ◽

Rehabilitation Medicine ◽

Bone Transport ◽

Fixation Index ◽

Ilizarov Method ◽

Fixation Time ◽

Ilizarov Technique ◽

Non Union

Objective: To document the presentation of tibial infected non-union and analyze the management outcome with Ilizarov technique in terms of bone results, functional outcome, bone transport time, external fixation time, external fixation index and any complications. Methods: This case series was conducted at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Civil hospital, Quetta over a period of 3-years. Results: There were 56 patients with 53(94.64%) males and 3(5.35%) females. The age range was 16-50 years with a mean of 32.58±9.98years. According to ASAMI criteria, bone results were excellent in 37(66%), good in 10(17.85%), fair in 6(10.71%) and poor in 3(5.35%). The functional results were excellent in 37(66%), good in 9(16%), fair in 7(12.5%) and poor in 3(5.35%). The bone union rate was 98.21%. Conclusion: Ilizarov method beautifully addresses the formidable issue of infected non union of tibia with good outcome in terms of bone healing and infection eradication. The treatment period is relatively lengthy and hence patience on part of patient as well as the surgical team is imperative for achieving favourable outcomes. How to cite this:Bakhsh K, Atiq-Ur-Rehman, Zimri FK, Mohammad E, Ahmed W, Saaiq M. Presentation and management outcome of tibial infected non‑union with Ilizarov technique. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.67 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The The Evaluation of the Radiological and Functional Outcome of Distraction Osteogenesis in Patients with Infected Gap Nonunions of Tibia Treated by Bone Transport

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.112 ◽

2019 ◽

Vol 7 (4) ◽

pp. 559-566 ◽

Cited By ~ 1

Author(s):

Ayush Kumar Singh ◽

Mangal Parihar ◽

Syed Bokhari

Keyword(s):

Functional Outcome ◽

Distraction Osteogenesis ◽

Radical Resection ◽

Bone Transport ◽

Sensory Loss ◽

Functional Score ◽

Elderly Age ◽

Limb Reconstruction ◽

Non Union ◽

Healing Score

AIM: The aims of this investigation were: 1) to study the Functional outcome of performing distraction osteogenesis in cases of infected non-union of tibia treated with Ilizarov and Limb Reconstruction System, and 2) to study the Radiological outcome of performing distraction osteogenesis in cases of infected non-union of tibia treated with Ilizarov and Limb Reconstruction System. METHODS: The study was done with 27 patients of infected gap nonunions of the tibia at Sir JJ Hospitals, Mumbai from 2013-2016. After implant removal, if required radical resection of necrotic tissue and fractures were stabilised with Ilizarov or mono-lateral fixator depending on non-union site. Corticotomy was either done proximally or distally. Patients were followed up at monthly intervals for a minimum of 6 months. RESULTS: The ASAMI-Bone healing score was Excellent or Good in 86% patients, and Functional score was Excellent or Good in 89% of patients. The commonest problems were of pin tract infection, wire loosening and angulation of the transported segment. CONCLUSION: Elderly age, persistent infection, sensory loss in the foot, the stiffness of the knee, and above all the patient’s reluctance to go any further given the protracted treatment besides, systemic disorders such as diabetes are all pointers for considering amputation as an alternative.

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