Ilizarov strategies in the management of nonunions and difficult fractures of the femur

Abstract

Introduction: Infected nonunion, neglected open fractures, aseptic nonunion, and neglected displaced comminuted fractures are difficult fractures of femur requiring tailored management. We used Ilizarov principles and strategies in such difficult presentations and the aim to evaluate results. Materials and Methods: Thirty-eight patients (37 males and 1 female), 3–48 years old, with infected nonunion (11 cases), neglected open fractures (12 cases), aseptic nonunions (9 cases), and neglected displaced comminuted fractures (6 cases) treated during 2000–2015 were evaluated. Cases of infected nonunion were subclassified using Rosens's classification to guide debridement and underwent single-stage monofocal or bifocal treatment. Neglected open fractures were Type 3 open fractures (Gustillo Anderson) after ≥12 h of injury-underwent debridement and single-stage monofocal or bifocal treatments. Aseptic nonunion cases underwent implant removal and monofocal or bifocal treatment. Neglected displaced comminuted fractures were fixed in situ, monofocal treatment, length, and rotation correction was done. Accordion maneuver was used extensively. No bone grafting was done. Results: Thirty-six cases (95%) achieved successful union and 97% cases had infection eradication. Excellent-to-good bony and functional results were seen in 86% and 68% cases, respectively (ASAMI criteria). Complications such as soft-tissue interposition (5%), Grade III pin-tract infection (13%), and hyporegenerate (11%) were seen. Discussion and Conclusion: With Ilizarov strategies tailored for specific situation, satisfactory and predictable results can be obtained offering one-stage solution to the global problems associated with such difficult fractures. The technique obviates need for bone graft or major soft tissue reconstruction.