Comparision of ilizarov ring fixator and rail fixator in infected nonunion of long bones: A retrospective followup study

Background: Nonunion of long bone fractures is a common condition treated by an orthopaedic surgeon. Many nonunions can be treated effectively by internal fixation with or without bone grafting but, an infected nonunion can prove to be a tough challenge. The Ilizarov method is effective in managing infected nonunion of long bones. This study aims to assess the outcome of management of infected nonunions of long bones of lower limb with Ilizarov Ring fixator using bone and functional results as per Association for the Study and Application of Methods of Ilizarov (ASAMI) Scoring System.Methods: We retrospectively analysed 18 patients (16 Male: 2 Female; Mean age 43.2 years) managed with Ilizarov technique for an infected tibial or femoral nonunion between 01 January 2013 and 31 December 2014. They were followed up for an average of 25.4 months after removal of fixator. They were assessed for functional and Bone (radiological) outcomes using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.Results: 17 limbs were salvaged and union could be achieved. One limb required amputation due to severe persistent intractable infection. None required any additional skeletal stabilisation after removal of fixator frame except casting in a few patients for a period of 6 weeks. Mean time to union was 211.83 days (range 136 - 320days/median 184) or 7.01 months. As per the ASAMI score, Bone results were excellent in 10, good in 5, fair in 2 and poor in 1. Functionally 7 were graded as excellent, 6 as good, 3 as fair and 1 as poor and 1 patient underwent amputation.Conclusions: The Ilizarov’s method remains one of the most versatile and successful means of achieving bone healing in infected nonunions of long bones of lower limbs with additional benefits of correcting bone defects, deformities and limb length inequalities.

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Outcomes of Ilizarov Ring Fixator in Infected Nonunion of Tibia

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i47a33067 ◽

2021 ◽

pp. 724-730

Author(s):

Muhammad Hamayun Hameed ◽

Abdul Hamid Kakar ◽

Hassan Amir Us Saqlain ◽

Syed Sajid Hussain ◽

Masood Ahmed Qureshi ◽

...

Keyword(s):

Functional Outcomes ◽

Functional Results ◽

Bony Union ◽

External Fixators ◽

Infected Nonunion ◽

Ring Fixator ◽

Ilizarov Ring Fixator ◽

Ilizarov Fixator ◽

Poor Outcomes ◽

Tibial Mechanical Axis

Objective: This study was designed to evaluate the effectiveness of Ilizarov. We aimed to explore the infection rate, bony union, and functional outcomes of Ilizarov fixators. Methodology: This retrospective study was conducted in Orthopedic department of Bolan Medical Complex Hospital Quetta Pakistan from June 2020 to June 2021. In this timeframe total of fifty-five patients of infected nonunion tibia were enrolled for Ilizarov technique treatment. For surgical intervention, patients were placed in a supine position on a radiolucent table. Ilizarov fixator was prepared on the behalf of patient's limb length, infection site, and ankle and knee functional status. We applied assembled Ilizarov fixator at the tibial shaft while keeping in mind that the rings were positioned in on the proximal and distal fragments. The ring was placed parallel to the joints whereas pins were inserted perpendicular to the tibial mechanical axis. Results: A total of 55 patients were recruited for this study. The mean age of the selected participants was 45.65±16.69 years. The overall successful bone results of the ASAMI score were observed as 80% whereas 88% functional outcomes were achieved. In bone results, we observed 28 (50.9%) cases with excellent results, 16 (29%) with good, 7 (12.7%) with fair, and 3 (5.4%) with poor outcomes. On the other hand, 25 (45.4%) cases observed excellent functional results, 25 (45.4%) with good, 4 (7.6%) with fair, and 2 (3.6%) with poor outcomes. Conclusion: Our results show a high success ratio therefore we recommend Ilizarov external fixators for infected nonunion tibial fracture. This method helps to recover limbs without any amputations. However, the discomfort of patients is one of the main problems with this method of treatment.

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Use of Ilizarov ring Fixator in the Management of Non-Union of Long Bones

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v5i2.06 ◽

2017 ◽

Vol 05 (02) ◽

pp. 17265-17268

Author(s):

Dr Kishore S ◽

Keyword(s):

Long Bones ◽

Non Union ◽

Ring Fixator ◽

Ilizarov Ring Fixator

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

The Journal of Knee Surgery ◽

10.1055/s-0038-1677512 ◽

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.

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ILIZAROV TECHNIQUES

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.06.1619 ◽

2016 ◽

Vol 23 (06) ◽

Author(s):

Mohammad Haroon Chohan ◽

Krishan Lal ◽

Muhammad Bux Chachar ◽

M Akhter Baig ◽

Sunil Kumar ◽

...

Keyword(s):

Weight Bearing ◽

Case Series ◽

Full Weight Bearing ◽

Soft Tissue Coverage ◽

Necrotic Bone ◽

Infected Nonunion ◽

Ring Fixator ◽

Ilizarov Ring Fixator ◽

Radical Debridement ◽

K Wires

Objectives: 1. To assess the results of infected nonunion of tibia by Ilizarovtechniques. 2. To ascertain the incidence of complications and advise methods to prevent them.3. To determine various risk factors which contribute to these complications. Study Design: Thisdescriptive case series. Setting: Department of Orthopaedic Surgery, Dow University of HealthSciences/ Civil Hospital Karachi. Period: 1st March 2010 to 28th Feb. 2013. Methods: A total of 30patients with infected nonunion of tibia with or without shortening and bone loss was includedin the study. Patients lying in supine position, after spinal anesthesia, radical debridement weredone and all previous infected implants and necrotic bone removed, pre-assembled ilizarovframe was applied with the help of four or five rings, each ring was fixed with k-wires andschanz pins. Olive wires were used where interfragmentary compression, correction of axialdeviation of fragment, in osteoporotic bones, transport of fibular fragment or more stability wasrequired. Results: Results were divided into bony and functional parts by ASAMI. We achieveexcellent to good bony result in 86.66% (26/30) of cases and excellent to good functional resultin 76.66% (23/30) of cases. Conclusion: It is concluded that bony and functional outcome ofinfected nonunion of tibia treated with ilizarov ring fixator is satisfactory. Although its applicationis lengthy but once applied patients get benefits, they can start walking with full weight bearing,limb length equality and soft tissue coverage achieved, so we recommend its applications insuch type of cases.

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Ilizarov ring fixator in treatment of infected nonunion of tibia

Saudi Journal of Sports Medicine ◽

10.4103/1319-6308.180189 ◽

2016 ◽

Vol 16 (2) ◽

pp. 159

Author(s):

Arunima Chaudhuri ◽

ArnabKumar Samanta ◽

Soumya Ghosh ◽

SudipChandra Mondal

Keyword(s):

Infected Nonunion ◽

Ring Fixator ◽

Ilizarov Ring Fixator

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ILIZAROV RING FIXATOR IN THE MANAGEMENT OF INFECTED NONUNION OF TIBIA - A CLINICAL STUDY

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2016/1546 ◽

2016 ◽

Vol 5 (92) ◽

pp. 6835-6841

Author(s):

Dennis Antony ◽

Rajany Jose

Keyword(s):

Clinical Study ◽

Infected Nonunion ◽

Ring Fixator ◽

Ilizarov Ring Fixator

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519 Outcomes of Management with Ilizarov Frames in Bone Infection: An Observational Study

British Journal of Surgery ◽

10.1093/bjs/znab259.995 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

C Marshall ◽

J Butler

Keyword(s):

Anaerobic Bacteria ◽

Clinical Effectiveness ◽

Bone Infection ◽

Ring Fixator ◽

Increased Risk ◽

Bone Void Filler ◽

Ilizarov Ring Fixator ◽

Cost Effect ◽

Biocomposite Material ◽

Bone Void

Abstract Aim The successful treatment and eradication of bone infection requires a multifaceted approach and may recur even after excision if resultant bone void is not managed effectively. This paper aims to review the clinical effectiveness of antibiotic-impregnated bone void filler and current empirical antibiotic guidelines. Method We report a retrospective study of 18 patients with chronic osteomyelitis following injury or surgery managed via Ilizarov Ring Fixator (IRF). All patients were managed by IRF stabilisation procedures with debridement, microbiological sampling, and bone void filling with antibiotic-impregnated biocomposite material, in addition to culture-specific systemic antimicrobial therapy. Results Patients were followed up for a mean of 15.9 months. Infection was eradicated in 94.1% of patients in a grossly comorbid demographic. Comorbidities associated with increased risk of osteomyelitis were noted in 72.2% of patients. Anaerobic bacteria were identified in culture for four (22.2%) of the 18 patients. Conclusions We detected a higher than suspected growth of anaerobes in our samples, suggesting the need for metronidazole in empirical antibiotic treatment. This study would suggest that the use of STIMULAN® may be preferable in this National Health Service from a cost-effect perspective, as our results are comparable to those using other bone void fillers.

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