Staged correction of varus knee and lateral thrust in an achondroplastic (ACH) juvenile patient who underwent limb lengthening with IM nails: tips for proper timing and prioritisation of procedures

We present the case of a fifteen-year-old achondroplastic (ACH) woman who requested to have her femurs lengthened by intramedullary nails. She had undergone bilateral tibial lengthening at the age of eleven and presented with a varus deformity of the right lower limb, lateral thrust of the right knee and valgus deformity of the left lower limb. We performed deformity analyses based on mechanical axis measurements, and we came with a staged surgical plan. In ACH adolescences, correction of bony deformity needs to encounter continuous fibula growth dynamics. Lateral knee thrust was corrected by gradual distal translation of the fibula head via an Ilizarov frame and the amount of translation we decided clinically. Tibial lengthening and valgus osteotomy of the distal femur accentuate lateral collateral ligament (LCL) complex laxity. In patients with ACH, tibial lengthening and valgus osteotomy of the distal femur—if needed—should precede LCL complex tightening, and femoral lengthening should follow.

Talo-calcaneal distraction Ilizarov frame: an ergonomic method to manage intra-articular fractures of calcaneum

Background: Principle of distraction and an indirect reduction was used to promote healing of fractures and adequate regeneration of cartilage at the subtalar joint. Aims and Objectives: The study was aimed to elaborate and develop role of Ilizarov as an alternative biologicalmethod to manage intraarticular fracture calcaneum with minimal chances of infection. Materials and Methods: Twenty-one patients were studied and the mean age of patients was 40.7 years (span: 20 to 65 years). Sanders CT classification was used to divide into type II, 11 (52.38%); type III, 7 (33.33%) and type IV, 3 (14.28%). The average followup was 17.2 months (range: 6 to 24 months). AOFAS scale for ankle and hindfoot was used for assessment of patients- 7 (33.33%) excellent, 7 (33.33%) good, 3 (14.28%) fair, and 4 (19.04%) poor results. The average score was 81.5 ±12.1. The mean period of treatment was 12 weeks (10 to 14 weeks). Results: On radiological assessment, Bohler’s angle change was 19.7±4.4 degrees to 33.51± 5.7 degrees; angle of Gissane changed from 126.4 ± 6.7 degrees preoperatively to 124.9 ± 6.9 degrees postoperatively; calcanealheight changed 40.14 ± 1.98 mm preoperatively to 43.33 ± 1.87 mm and width changed 45.09 ±3.65 mm preoperatively to 43.09 ±3.16 mm postoperatively and reduction malalignment >10 degrees in 5 patients. Superficial skin infection at wire insertion sites was the most common complication encountered in our cases. Conclusion: Our results with this ergonomic technique in a small number of 21 non-randomised cases with a mean followup of 17.2 years attribute towards an alternate surgical substitute to conventional open reduction techniques in the treatment of intra-articular fractures of calcaneum having lesser rate of complications.

Utility of Ipsilateral Medial Fibular Transport Using the Ilizarov Frame in the Treatment for Non-elderly Patients Sustaining Massive Tibial Bone Defects as a Sequela of Trauma and Infection: A Systematic Review

Introduction and Objectives. Segmental tibial bone loss from tumor, trauma, or infection is a debilitating, limb-threatening scenario where treatment principles involve aggressive resection of infected tissues usually leading to large defects requiring reconstruction. A systematic review was conducted to determine the best available evidence related to the ipsilateral medial fibular transport using the Ilizarov frame in the management of these massive tibial bone defects. Methods. Multiple medical online database search for articles containing the keywords: ipsilateral medial fibular transport, medial fibula transport, medialization of the fibula using the Ilizarov fixator, ring external fixator, vascularized free fibula, vascularized fibula transfer, and other related MeSH terms was done. Data was summarized to describethe mean age, bone defect, external fixator time, external fixator index, and bone and functional results using the ASAMI criteria. Results. Eight studies with a total of 43 patients with massive tibial bone defects treated by fibular transport using the Ilizarov methods were identified. The mean age was 25.27 years (6.5-44.4) with a mean bone defect of 13.57 cm (9.52-17). The mean length of follow-up was 37.67 months (18-70.2). The bone union rate was 100%. Mean external fixation time was 9.59 months (8.31-10.88) and external fixation index was 0.61 months/cm (0.52-0.70). The majority of patients have an excellent bone (84%) and functional (52%) results. The average rate of complication was determined at 0.74/patient (95% CI, 0.60-0.89). The most common complications include pin-tract infection (37%), residual loss of motion/stiffness of knee and ankle (35%), and pain on the transport site (21%). Conclusion. Ipsilateral medial fibular transport using the Ilizarov frame provides a viable alternative treatment option for the treatment of massive tibial bone defects.

Repair of an open forearm fracture and extensive bony loss (case report)

Introduction Repair of a double open comminuted fracture of forearm bones with extensive bony loss is challenging due to a high risk of infection and the need to address a significant bony defect. Neither internal fixation nor open reduction could be considered due to substantial bone loss and severely impaired circulation with a high risk of soft tissue necrosis and infection. We report staged management of forearm fracture using avascular autologous graft to repair the defect and maintain the forearm length. Objective Demonstrate the successful management of the double open comminuted fracture of forearm bones with extensive bony loss using Ilizarov external fixation, classical autologous grafting harvested from fibula and intramedullary (IM) nailing. Results and discussion The limb was temporarily fixed with Ilizarov frame in an extra-focal manner. An autogenous fibular graft of 11 cm was used to fill in the gap. Intramedullary nailing of the radius and ulna was produced and ulnar defect was repaired with autogenous fibular graft. IM nails were removed once the bones consolidated. The limb function was completely regained, anatomical length of the segment maintained and metal constructs removed. Conclusion Combination of different bone fixation modalities, classical autografting technique and intramedullary nailing provided complete recovery of the broken limb maintaining the function and bringing down the risk of complications to ensure a good clinical result.

Treatment of posttraumatic patella osteomyelitis with MRSA infection and knee stiffness: a case report

Background Posttraumatic patella osteomyelitis is rare, and the treatment of osteomyelitis remains to be challenging. Control of the infection commonly costs a long time, and it is easily to cause knee stiffness. In addition, there is no unified protocol for the treatment of knee stiffness. Case presentation We reported a case of posttraumatic patella osteomyelitis that successive infected with methicillin-resistant staphylococcus aureus (MRSA) after multiple surgeries. We successfully treated osteomyelitis by one-staged surgery, but the patient present knee stiffness after treatment. Thus Ilizarov external fixation system was further used to gradually adjust the mobility by exerting mechanical stress to the joint. After adjusting the frame under a scheduled plan, the patient successfully restored satisfactory knee function. Conclusions Adequate debridement is the key to control infections of posttraumatic osteomyelitis. Control the infection of posttraumatic patella osteomyelitis by one-staged surgery is achievable and could shorten the knee immobilization period. When knee stiffness occurs, scheduled range of motion (ROM) adjustment using Ilizarov frame with hinges might be a safe and useful method to restore function.

Effect of the Ilizarov Bone Fixation on Gait Cycle and Its Parameters

<p>Walking is the first manner of displacement for human and essential for daily life activities. The human gait can be analyzed from several points of view and specialization. The Ilizarov frame is an external fixation device, primarily used for the treatment of complex fractures which adversely affects the functional state of the locomotor system. The objective of this paper was to analyses the spatiotemporal parameters of gait during treatment by the Ilizarov technique. <strong>Materials and methods:</strong> The study consists of 6 males with lower limb injuries performed walking trials, with and without the Ilizarov frame. Gait analysis was carried out using a camera and Kinovea application. <strong>Results:</strong> walking speed (p = 0.385), stride length (p =0.325), cadence (p = 0.641), stance time of operated limb (p = 0.265), swing time of operated limb (p = 0.959), double support time of operated limb (p=0.227) respectively were all no important difference with Ilizarov and without it. The times (stance, swing, and double support) (p=0.018) for non-operated limb have significantly different with Ilizarov.</p>

Ortho-Plastic Approach in Management of Open Pilon Fractures

Category: Trauma; Ankle Introduction/Purpose: The BOAST (British Orthopaedic Association Standards for Trauma) guidelines do advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines including relatively aggressive bone debridement. Methods: A retrospective analysis of open pilon fractures treated between 2014 and 2019 was conducted. Injuries were graded according to the Gustillo-Anderson classification and all patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot & Ankle Score (AOFAS) at 6 months after definitive surgery. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 (Range: 3-24) hours. Definitive fixation was performed when the wound was healed, with the mean time from primary surgery to definitive surgery being 24.5 (Range: 7-60) days. Results: There was a total of 20 patients. The mean age was 50.5 (Range: 16-88) years. Follow-up was for an average of 25.1 (Range: 9-36) months. There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 9.3 (Range: 4-18) months. The mean AOFAS score was 64.4 (Range: 15-90). Definitive treatment via Taylor Spatial Frame was performed on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement, while 3 patients had Stimulan beads with antibiotics. There were no cases of deep infection, however a superficial wound infection was found in 9 patients (45%). Conclusion: Results of our study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with antibiotics, external fixators and patient tailored timing of definitive surgery achieves low rates of wound infection and complications for patients with open pilon fractures. We suggest treating these fractures with the availability of Orthoplastic care and with an MDT approach.