scholarly journals An Unusual Case of an Extensive Proximal Tibia Bone Defect Secondary to Complicated Cellulitis Managed by Unifocal Bone Transport Using an Ilizarov Fixator

2021 ◽  
Vol 2 (2) ◽  
pp. 66-70
Author(s):  
Venkataram V
Keyword(s):  
Bone Defect ◽  
Proximal Tibia ◽  
Present Report ◽  
Bone Defects ◽  
Bone Transport ◽  
Left Knee ◽  
Prior History ◽  
Ring Fixator ◽  
Ilizarov Ring Fixator ◽  
History Of

Introduction Bone defects occur following bone loss secondary to trauma or due to infection. Extensive bone defects are usually seen in the former. It is unusual to have large defects in isolated osteomyelitis without prior history of any trauma. We are reporting a case with a bone defect of around 17 cm due to infectious aetiology and its management by unifocal bone transport using the Ilizarov ring fixator. Case Report The present report describes a 45-year-old gentleman with newly diagnosed diabetes mellitus who was initially admitted under general surgery for management of cellulitis and was later admitted under orthopedics for suspected osteomyelitis of left proximal tibia and septic arthritis of left knee. Serial debridement, prolonged antibiotic therapy and skeletal stabilization by a temporary joint spanning external fixator was applied to control the infection. The infection finally resolved after 6 weeks with a bone defect of approximately 17 cm. Options for reconstruction were discussed with the patient along with their pros and cons. Unifocal bone transport by ilizarov ring fixator was finalized with the patient’s consent with the aim of achieving a functional limb. Bone healing index was 1.17 months/cm. ASAMI scoring showed excellent bone result and good functional result. LEFS was 55/80. The lower scores were because of the fused knee. Conclusion To the best of the authors’ knowledge this is the largest defect secondary to infection without history of trauma which has been successfully treated by unifocal bone transport.

scholarly journals OSTEOGENESIS DISTRACTION USING COMBINED PLATE AND ILIZAROF FIXATOR IN THE TREATMENT OF BONE DEFECT: A CASE REPORT

Biomedika ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 113-120
Author(s):  
Misbahuddin Misbahuddin ◽  
Ismail Mariyanto
Keyword(s):  
Bone Loss ◽  
External Fixation ◽  
Bone Defect ◽  
Plate Fixation ◽  
Bone Transport ◽  
Fixation Index ◽  
Bone Fragment ◽  
Ring Fixator ◽  
Ilizarov Ring Fixator ◽  
Bone Segment

Distraksi osteogenesis dan pemanjangan tulang telah digunakan untuk merekonstruksi hilangnya tulang dengan memungkinkan tulang baru terbentuk pada celah. Pada penelitian sebelumnya, pemanjangan tulang yang dipandu pelat telah berhasil mengobati hilangnya  tulang pada tulang paha, tibia, dan mandibula. Penelitian ini melaporkan sebuah kasus fraktur tibia dengan kehilangan tulang kominutif yang diobati dengan fiksasi pelat dan pemanjangan tulang dengan fiksator cincin Ilizarov. Pada saat pengaitan, ketika segmen pemanjangan dikompresi dengan fragmen tulang, fragmen tulang difiksasi dengan sekrup locking dan non-locking tambahan melalui pelat. Panjang defek tulang adalah 7 cm. Indeks pemanjangan atau fiksasi eksternal adalah 12,7 hari / cm. Pada kasus ini tidak ada pemendekan yang terjadi. Indeks konsolidasi radiografi rata-rata adalah 37 hari / cm. Kasus ini  mencapai regenerasi segmen tulang yang bebas infeksi dan hasil fungsional yang memuaskan. Teknik ini mengurangi durasi fiksasi eksternal selama fase konsolidasi, memungkinkan koreksi panjangtulang, dan penyelarasan dan waktu rehabilitasi yang lebih singkat.\Kata kunci: Defek Tulang, Transportasi Tulang, Osteogenesis Gangguan, Teknik Ilizarov, Osteogenesis Lempeng TulangOsteogenesis distraction and bone transport has been used to reconstruct bone loss defect by allowing new bone to form in the gap. In previous studies, plate-guided bone transport has been successfully to treat bone loss defect in the femur, tibia, and mandible. This study reports a case of fracture of tibia with comminutive bone loss treated with plate fixation and bone transport with Ilizarov ring fixator. At the time of docking, when the transport segment is compressed with bone fragment, the bone fragment is fixed with additional locking or nonlocking screws through the plate. The bone defect size was 7 cm. The lengthening/external fixation index was 12.7 days/cm. In this case there were no shortening that  present. The average radiographic consolidation index was 37 days/cm. This case achieved infection-free bone segment regeneration and satisfactorily functional outcome. This technique reduces the duration of external fixation during the consolidation phase, allows correction of length and alignment and provides earlier rehabilitation.Keywords: Bone Defect, Bone Transport, Distraction Osteogenesis, Ilizarov Technique, Bone Plate Osteogenesis

scholarly journals Extreme bone lengthening by bone transport with a unifocal tibial corticotomy: a case report

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hongjie Wen ◽  
Huagang Yang ◽  
Yongqing Xu
Keyword(s):  
Bone Defect ◽  
External Fixator ◽  
Bone Repair ◽  
Bone Defects ◽  
Bone Transport ◽  
External Fixators ◽  
Bone Lengthening ◽  
Fracture Nonunion ◽  
Defect Repair ◽  
The Right

Abstract Background Bone transport is used for the treatment of extensive limb bone defects. The application of ring or unilateral external fixators combined with single or double corticotomy are well documented; however, there are few cases adopting a single corticotomy to repair bone defects > 24 cm. Case presentation The present case study describes an 18-year-old male, who was involved in a traffic accident and was diagnosed with open fracture of the right tibia. The patient received emergency surgery in a local hospital and was transferred to The Second People’s Hospital of Yunnan for further treatment 3 months later. The patient was diagnosed with fracture nonunion and infection following admission. Complete debridement was performed three times to control the infection. The infection was resolved after 26 days and the 24.5 cm massive tibia defect remained the biggest challenge. The bone transport technique involving a unilateral external fixator and single corticotomy was employed to treat the bone defect. Docking site union was achieved and bone consolidation was complete 40 months after corticotomy. The external fixator was subsequently removed. The bone healing index was 1.6 months/cm. The Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) revealed a good functional and bone repair result. Similarly, Knee Society Score (KSS) yielded good result and the The Lower Extremity Functional Scale (LEFS) was 65. A total of 45 months after injury, the patient was able to walk painlessly without ambulatory assistive devices and resumed daily activities successfully. Eighteen months after the bone and soft tissue wound have healed, the SF-36 score was 86, and the LEFS was 70. Conclusion To the best of the authors’ knowledge, the present study described the longest bone defect repair performed using bone transport with single level corticotomy.

Management of Chronic Infected Intra-Articular Fractures of the Proximal Tibia with Ilizarov Ring Fixation

2019 ◽  
Vol 33 (02) ◽  
pp. 213-222
Author(s):  
Kaushik Bhowmick ◽  
P.R.J.V.C. Boopalan ◽  
Chandrasekaran Gunasekeran ◽  
Abel Livingston ◽  
Thilak Samuel Jepegnanam
Keyword(s):  
Bone Loss ◽  
Tibial Plateau ◽  
Proximal Tibia ◽  
Care Hospital ◽  
Infected Nonunion ◽  
Ring Fixator ◽  
Articular Fractures ◽  
Ilizarov Ring Fixator ◽  
Metaphyseal Bone ◽  
Internal Transport

AbstractInfected nonunion and malunion of tibial plateau are rare injuries with no standardized protocols for treatment. This study assessed the outcome of chronic infected intra-articular proximal tibial fractures with and without metaphyseal bone loss managed with the Ilizarov ring fixator. A series of six patients of intra-articular infected nonunion of the tibial plateau and two patients with malunited plateau with metaphyseal nonunion were treated in a tertiary care hospital. Three of these eight patients had a metaphyseal bone loss or bone gap after debridement and underwent internal transport with distal corticotomy to obtain the bone length. The remaining five patients underwent static ring fixation after correction of the articular deformity. Clinical evaluation was done by Knee Society Score, Rasmussen radiological and Association for the Study and Application of Methods of Ilizarov scores. All patients but one achieved union with the ring fixator. The average follow-up was 33 months (range, 12–120 months). Average time to achieve union was 11.5 months (range, 3–30). The scores were good in four patients and poor in the rest four, out of which three had undergone internal transport. Proximal tibia intra-articular infected nonunion and malunion with or without metaphyseal bone loss can be treated successfully with the Ilizarov fixator. Malunion of the tibial plateau has to be addressed in cases with varus alignment of the limb or articular step-off of ≥ 5mm between the two tibial surfaces. Patients with associated metaphyseal bone loss tend to have complications and take a longer duration to heal. Single-stage treatment avoids intra-articular malunion and loss of limb alignment.

Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects

2019 ◽  
Vol 101-B (2) ◽  
pp. 162-169 ◽  
Author(s):  
M. A. Catagni ◽  
W. Azzam ◽  
F. Guerreschi ◽  
L. Lovisetti ◽  
P. Poli ◽  
...  
Keyword(s):  
Bone Defect ◽  
Treatment Time ◽  
Operating Time ◽  
Functional Results ◽  
Bone Defects ◽  
Bone Transport ◽  
Fixation Time ◽  
Tibial Bone ◽  
Transport Distance ◽  
The Difference

Aims Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated. Patients and Methods A total of 86 consecutive patients with a long tibial bone defect (≥ 8 cm), who were treated between January 2008 and January 2015, were retrospectively reviewed. A total of 45 were treated by BFT and 41 by TFT. The median age of the 45 patients in the BFT group was 43 years (interquartile range (IQR) 23 to 54). Results The size of the bone defect was significantly longer (p = 0.005), the number of previous operations was significantly higher (p < 0.001), the operating time was significantly longer (p < 0.001), and the bone transport distance was significantly increased (p = 0.017) in the TFT group. However, the external fixation time (p < 0.001), the healing index (p < 0.001), the number of additional procedures (p = 0.013), and the number of true complications (p < 0.001) were significantly reduced in this group. Both groups achieved highly satisfactory bone and functional results. Conclusion TFT can significantly reduce the treatment time, the number of additional surgical procedures, and true complications compared with BFT in the treatment of long segmental tibial bone defects.

Increased Lead Burden and the Energy Crisis

PEDIATRICS ◽  
1975 ◽  
Vol 55 (4) ◽  
pp. 573-573
Author(s):  
F. J. deCastro ◽  
J. Lazzara ◽  
U. T. Rolfe ◽  
E. Engeler
Keyword(s):  
Physical Examination ◽  
Neurological Examination ◽  
Blood Lead Level ◽  
Present Report ◽  
Lead Level ◽  
Blood Lead ◽  
Left Knee ◽  
Abnormal Behavior ◽  
Energy Crisis ◽  
History Of

The present report describes a child with increased lead burden due to inhalation of fumes from lead-base-painted wood burned in an old faulty furnace. A 5-year-old boy was referred while asymptomatic with a blood lead level of 67µg/100 ml (atomic absorption). He had no history of pica or abnormal behavior. Physical examination revealed a small, alert, thin white boy whose physical and neurological examination were normal Hemoglobin and urinalysis were normal. Radiographs of the abdomen, left knee, and right elbow were normal.

ASPERGILLUS FUNGUS BALL: HEMOPTYSIS IN PATIENT WITH PRIOR HISTORY OF CURED PULMONARY TUBERCULOSIS

2020 ◽  
Vol 7 (1) ◽  
pp. 41-43
Author(s):  
Ana Flávia de Oliveira Castro ◽  
José Manoel Dos Santos Júnior ◽  
Káritas Rocha Cardoso
Keyword(s):  
Pulmonary Tuberculosis ◽  
Medical Records ◽  
Small Volume ◽  
Present Report ◽  
Previous History ◽  
Prior History ◽  
Fungus Ball ◽  
Hospitalization Period ◽  
History Of ◽  
Appropriate Therapy

ABSTRACT Lung aspergilloma consists of a fungal mass composed predominantly by Aspergillus fumigatus formed within a prior lung cavity, in greater numbers in healed tuberculosis caverns. Clinically, it is marked by patients in their fourth or fifth decade of life presenting most commonly repeating episodes of small volume of hemoptysis. The present report describes the case of a 66-year-old male patient, admitted with hemoptysis of large amount associated with dyspnea, and past pathological history of hemoptysis episodes more than 24 years after diagnosis and treatment of tuberculosis in 1994. Data were obtained through analysis the patient’s medical records and laboratory and imaging exams performed on the patient during the hospitalization period. This paper highlights a relevant cause of hemoptysis in patients with previous history of tuberculosis and clarifies the clinical and imaging investigation for timely diagnosis and appropriate therapy in such cases.

scholarly journals Managing Difficult Fractures due to Ballistic Trauma with Ilizarov Ring Fixation

1970 ◽  
Vol 9 (1) ◽  
pp. 1-8 ◽  
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

scholarly journals Complications of bone transport technique using the Ilizarov method in the lower extremity: a retrospective analysis of 282 consecutive cases over 10 years

2020 ◽  
Author(s):  
Yanshi Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Jialin Liu ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Clinical Outcomes ◽  
Bone Defect ◽  
Demographic Data ◽  
Bone Defects ◽  
Bone Transport ◽  
Lower Limbs ◽  
Ilizarov Method ◽  
Major Complications ◽  
Transport Technique

Abstract Background: The treatment of large bone defects in lower limbs is a serious challenge for orthopedic surgeons and patients. The bone transport technique using the Ilizarov method has become the main treatment option for the reconstruction of bone defect. However, inevitable difficulties and complications related to bone transport technique have been reported by many studies. The purpose of this study was to evaluate the effectiveness and complications of bone transport technique using Ilizarov method in the treatment of bone defect of lower extremity.Methods: The study was conducted on 282 patients who underwent bone transport procedures using Ilizarov method at our institution from January 2007 to June 2017. Patient’s demographic data, complications and clinical outcomes at minimum of two years follow-up were collected and retrospectively analyzed. All difficulties that related to bone transport were documented according to Paley’s classification. The clinical outcomes were evaluated using Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at last clinical visit. Results: There were 243 male and 39 females with a mean age of 40 years (range 18-65 years). The mean defect was 6.56±2.15 cm, whereas single level transport in 221 cases and double level transport in 61 cases. There were 189 problems, 166 obstacles and 406 complications (257 minor and 149 major complications), and the average complication rate per patients consists of 0.91 minor and 0.53 major complications. The top five complications were pin-site infection (65.96%), axial deviation (40.78%), joint stiffness (23.76%), soft tissue incarceration (22.34%) and delayed union of the docking site (13.48%).The ASAMI bony result was excellent in 233 patients, good in 32, fair in 5 and poor in 12. The ASAMI functional result was excellent in 136 patients, good in 88, fair in 47, poor in 11.Conclusion: Bone transport is a reliable method for reconstruction of bone defects in the femur and tibia. Awareness of predictable complications is beneficial to prevent or early detection of the expected complication which can improve the risk-benefit balance.

scholarly journals Segmental Bone Defects and the History of Bone Transport

2021 ◽  
Vol 35 (4) ◽  
pp. S1-S7
Author(s):  
Mark Thomas Dahl ◽  
Stewart Morrison
Keyword(s):  
Bone Defects ◽  
Bone Transport ◽  
History Of ◽  
Segmental Bone ◽  
Segmental Bone Defects
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