Outcomes of Ilizarov Ring Fixator in Infected Nonunion of Tibia

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.

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

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.

Functional Outcome of Open Tibial Fracture Using Illizarov Apparatus

The better treatment for tibial fractures are very vague and difficult. Since the tibia is covered by soft tissue coverage fixing of plate becomes very difficult as it creates wound complications, mainly in case of severe fractures.In this study of 20 cases of open communited fractures of tibia with the Ilizarov ring fixator hybrid technique was used, it was found that this technique has a major advantages in treatment and management of the tibial fracture.

Illizarov’s technique outcome in non-union tibial fracture

<p class="abstract"><strong>Background:</strong> Tibia being a superficial bone of the body and vulnerable to trauma, often becomes fractured among all long bone fractures. Tibial surface is subcutaneous most of its length so open fractures are common.</p><p class="abstract"><strong>Methods: </strong>The present cross sectional study was conducted on 20 patients attending the outpatient department Of Orthopedics, Government Medical College and Hospital, Ambikapur, Sarguja (C.G) India between September 2020 to February 2021. Patients within the age group of 18-60 years, having fracture of any duration with gap non union and those having duration of fracture more than 36 weeks without bony gap were included in the study. Details of Patient’s characteristics concerning primary injury and treatment were recorded and evaluation of results were based on Paleys criteria.</p><p class="abstract"><strong>Results: </strong>In bone/radiological results, seven were classed as excellent, eleven as good with the remainder of 2 being fair and poor each. Functionally nine were graded as excellent, nine as good and two as fair and poor each.</p><p class="abstract"><strong>Conclusions:</strong> It was found that Ilizarov ring fixator is an excellent treatment modality for tibial non-union with infection. However the technique requires long treatment follow up. Multiple interventions may be necessary to overcome the difficulties which come across the treatment.</p>

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

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.

Talo-calcaneal smile osteotomy as a treatment of rigid residual equinus deformity

Foot deformities are usually complex. Equinus deformity can be a residual foot deformity element or isolated. A rigid type is the most difficult for treatment. The aim of work is the treatment of rigid equinus deformity by a minimally invasive technique using Ilizarov fixator to restore plantigrade foot and to prevent further recurrence. 17 feet in 14 patients with stiff ankles and rigid equinus after failed surgical correction of club feet, with mean age 6.6 years (4 to 10 years), all treated by smile talocalcaneal osteotomy and Ilizarov ring fixator with a mean follow up 20.9 months (5 to 30 months). 5 feet (29.9%) had excellent results, 8 (47.1%) had good results, 1(5.9%) had a fair result and 3 feet (17.6%) had poor results and underwent revision surgery. In conclusion, our technique Talo-calcaneal smile osteotomy based on distraction osteogenesis method appears to provide similar or better results compared to other literature results without discrimination of foot size, provide some range of motion and plantigrade foot. Keywords: Clubfoot- equinus- rigid -deformity, Ilizarov- Smile osteotomy.