Ilizarov Fixator Research Articles

Functional And Radiological Outcome of Schatzker Type V and VI Tibial Plateau Fracture Treated with Closed Reduction and Ilizarov Fixation with or without Minimally Invasive Screw Supplementation

Introduction: Controversy exists as to the best treatment approach for high-velocity tibial plateau fractures. This study was done to assess the functional and radiological outcome of Schatzker type V and VI tibial plateau fractures treated with closed reduction and Ilizarov ring fixation with or without cancellous screw supplementation. Methods: An analytical cross sectional study was conducted among 25 cases of both closed and open Schatzker type V and VI tibial plateau fractures treated with closed reduction and Ilizarov ring fixation with or without minimally invasive cannulated cancellous screw supplementation. The outcome variables analyzed were union time, knee range of motion, American Knee Society Score (AKSS), Rasmussen’s Radiological Score (RRS), and complications. Data analysis was done using SPSS-20. P-value <0.05 was considered as statistically significant. Results: There were 15 type V fractures, 10 type VI fractures, 21 closed fractures, and 4 open fractures. All the fractures united with a mean union time of 15.88 weeks (range 12-24). The mean American Knee Society score was 77.8 (range 68-95), Rasmussen’s radiological Score (RRS) 15.12 (range 10-18), and mean range of motion was 112.40 (range 90-135). Superficial pin site infection was present in 7 (28%) of the cases. There was no case of nonunion, deep infection, repeat surgery other than implant removal, or nerve palsy. Conclusions: Closed reduction and Ilizarov ring fixation with or without minimally invasive screw supplementation give rise to good to excellent functional and radiological outcomes in most of the cases in the treatment of Schatzker type V and VI tibial plateau fractures with minimal bone or soft tissue related complications.

The Use of the Ilizarov Fixator for the Treatment of Open and Closed Tibial Shaft and Distal Tibial Fractures in Patients with Complex Cases.

Open and closed fractures of the tibial shaft or distal tibia can be challenging for surgeons to treat if the fractures are accompanied by aggravating conditions, such as various accompanying diseases, pronounced soft tissue injuries, osteomyelitis, and/or noncompliance. The aim of this retrospective study was to present our approach and results with the Ilizarov fixator as a treatment option for such individually complex cases. Between 2005 and 2018, 20 patients were treated with the Ilizarov fixator for fractures of the tibial shaft/distal tibia. The indication for this was a 2nd- to 3rd-degree open fracture in 10 patients, a 1st-degree open fracture in one patient, and closed fractures in 9 patients. Aggravating conditions included soft tissue injuries, osteomyelitis, leg deformities, multiple traumas, smoking, alcohol/drug abuse, and obesity (BMI > 60). In addition to demographic data, the time of fixator treatment, complications, and the endpoint of consolidation were evaluated retrospectively. The mean time of fixator treatment was 29 (range 15-65) weeks. Complete fracture consolidation was achieved in 13 patients (65%) with the Ilizarov fixator. The mean follow-up period after fixator removal was 36 (range 2-186) months in 14 patients. Five patients with complete consolidation were lost to further follow-up. One patient was amputated. In six patients without union, internal osteosynthesis was carried out. The use of the Ilizarov fixator is a treatment option for individual high-risk patients with complicating courses but should be seen as a salvage procedure due to the high complication rate and long treatment process.

Comparative Outcome of Hybrid External Fixator Versus Primary Ilizarov Fixator in the Treatment of Open Distal Tibia Extra-Articular Fractures.

Because one-third of the tibia is subcutaneous throughout most of its length and its location, it is more prone to open fractures. Open distal tibia fractures are mostly due to RTA and sports injuries. The goal of treatment is to obtain a healed, well-aligned fracture; pain-free weight-bearing; and functional range of motion of the knee and ankle. 33 patients of the 18-60-year age group with open distal tibia extra-articular fractures (without vascular injury), less than 3weeks old trauma were included in the prospective study for 1year period (1st June 2019 to 31st May 2020). 17 cases were treated with the Hybrid external fixator (HEF) and 16 cases were treated with the Ilizarov fixator (IF). Significantly (P < 0.05), the mean duration of surgery was less in the HEF group (67.6min), faster union of open type-II fractures in the HEF group (16.4weeks), and also a higher AOFAS score at 6months in open type-II fractures in the HEF group (84.4). There were two cases of equinus deformity in the IF group and one case of valgus deformity in the HEF group. HEF and IF are both equally effective in the treatment of open distal tibia extra-articular fractures with the advantage of stable fracture fixation, early weight-bearing, preserving soft tissue, minimal periosteal stripping, and providing one-staged definitive intervention. However, HEF is preferred over IF in terms of less operating time, faster union, and a better functional outcome with minimal complications.

Management of fracture non-union long bones by limb reconstruction devices

Background: The limb reconstruction system (LRS), rail road fixator, and Ilizarov fixator are used to treat open fractures with bone loss and infective non-union of long bones. It benefits the fracture site by permitting distraction, compression, and further enhancing micromotion at the level of fracture site which plays an important part in healing. The LRS is a straightforward, unidirectional arrangement that provides exceptional strength and rigidity. The limb rebuilding procedure has proven to be an effective treatment option in instances of fracture infective non-union of long bones. Aims and Objectives: This study is to evaluate and to observe the use of limb reconstruction devices (such as the Ilizarov fixator and the rail road fixator) in the treatment of open fractures with bone loss and infective non-union of long bones. Materials and Methods: Twenty patients (15 males and five females) with fracture non-union of long bones were involved in this study after taking permission from ethic committee and consents from all 20 individuals. These patients then underwent thorough debridement and resection of non-viable bone ends with the application of limb reconstruction devices which were then followed by bone transport to fill the bone gap. This was done by means of Ilizarov in 13 patients and by rail road fixator in the remaining seven patients. The average time of union and complications were evaluated. Results: Mean duration of fracture union was 7.9 months. While one patient had failure resulting in non-union, other 19 patients achieved union by limb reconstruction devices. Majority of the cases had no complications. Mean period of hospital stay for Ilizarov was 68.13 days and for rail road fixator 53.17 days. After applying independent “t-test,” no statistically significant differences were observed in fracture union duration between Ilizarov and rail road fixator, since the calculated P value was observed to be &gt;0.05. Mean union of Ilizarov and rail road fixator application was found to be 7.6 months and 8.2 months, respectively. Conclusion: Limb reconstruction devices in our present study can be utilized as an effective way to tackle infective non-union of long bones and open fracture with bone loss for achieving better stabilization. Both Ilizarov and rail road fixator perform a crucial role in causing early mobilization of the patient and also in fracture union by distraction osteogenesis.

Outcomes of Primary Ilizarov Ring Fixator for Segmental Tibial Fracture with Compromised Skin: A Prospective Study

Background: Tibial diaphyseal fracture is the most commonly encountered fracture in orthopedic practice. There are various methods to treat the same, ranging from conservative to operative treatment. The operative methods include internal fixation using nailing and plating and external fixation using fixator/ring fixator. This study aims to evaluate the results of primary treatment of segmental tibial fracture in patients with a compromised skin condition using the Ilizarov fixator and look for complications.&#x0D; Methods: This prospective study was conducted at a tertiary level health care center. It included a series of 40 patients with segmental tibial fractures. Classification of the segmental tibial fractures was done according to Melis et al. The fixator was designed with three fixation blocks and two working length sections. The patients were evaluated for the progression clinically and radiographically at 2-week intervals for the first 2 months and were then followed by 4-week intervals. Results were evaluated according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) classification.&#x0D; Results: We treated 40 patients with a segmental tibial fracture with compromised skin using the Ilizarov ring fixator. Patients were followed up after surgery with an average follow-up of 13.8 months. The average union time came out to be 27.6 weeks for the proximal segment and 33.31 weeks for the distal segment. Out of the total patients, 15 (37.5%) patients had pin tract infection, and one (2.7%) patient had nonunion, which later required bone grafting. Bone results of patients at final follow-up as evaluated by ASAMI score were 91.7% excellent, 5.6% good, and 2.7% poor. Functional results of patients at final follow-up as evaluated by ASAMI score were 80.5% excellent, 1.7% good, and 2.8% poor.&#x0D; Conclusion: In the existing literature, segmental tibial fractures have always been difficult to treat. They are associated with high complication rates due to the lack of surrounding soft tissues. The proximal and distal fragments may be more difficult to treat because of the serious direct injury to the soft tissues overlying the segment and the difficulty stabilizing this bone segment with implants. With the use of Ilizarov technique, there is a good mean time to union, a low rate of reoperations, and good functional and general health-status outcome.

Pathomorphological and pathochemical characteristic of the osteomyelitis focus in patients with diabetic osteoarthropathy (Charcot foot)

BACKGROUND: Osteomyelitis in diabetic osteoarthropathy occurs in 65 % of cases, and it is the main cause of non-traumatic amputations. The choice of optimal treatment technologies should be based on understanding the pathogenetic characteristics of this disease.AIM: To study the pathomorphological and pathochemical picture of osteomyelitic focus in patients with diabetic neuroosteoarthropathy.MATERIALS AND METHODS: Object — 20 patients (55.3±9.33 years) with Type 2 diabetes mellitus, diabetic neuroosteoarthropathy, chronic osteomyelitis of the foot bones. The treatment consisted in surgical debridement of the purulent focus with the material collection for pathomorphological and biochemical studies, and in reposition and alignment of bone fragments with the leg and foot fixation using the Ilizarov fixator in order to form bone ankylosis of the compromised joint.RESULTS: Subacute and acute course of chronic osteomyelitis was registered in 80 % of cases. As for the pathohistological changes in bone tissue, the following ones were the most significant: necrosis and the presence of an inflammatory infiltrate of varying severity depending on the phase of the inflammatory process. The articular cartilage structure was broken in all the cases. Activation of osteoclasts was observed in the osteomyelitis focus, especially in the subchondral zone. There was no subchondral bone plate in most cases, or only its fragments remained. Pathohistological examination of the soft tissues associated with the osteomyelitis focus indicated the presence of mirocirculatory and denervation disorders due to necrosis and hyalinosis of a significant part of microvessels against the background of compensatory hypervascularisation and chronic inflammation, narrowing and obliteration of the lumens of feeding arteries, almost complete absence of nerve elements in the tissues or their destructive changes. An increase in the activity of lytic enzymes was revealed in the interstitial environment of the tissues surrounding the osteomyelitis focus (138-fold increase in the activity of acid phosphatase, interstitial osteolytic index was 7.2-fold higher than blood serum index).CONCLUSION: The pathomorphological signs of chronic osteomyelitis subacute and acute processing were observed in most patients. Breaking the articular cartilage structure was accompanied by invasion of vessels, inflammatory infiltrate, and by activation of osteoclasts in the subchondral zone. Destructive changes of vessels and nerves in the soft tissues associated with the osteomyelitis focus can be etiopathogenetic factors of this disease development. The technologies for stopping this process should be based on obligatory debridement of the focus with sequestrnecrectomy, with regular monitoring of the operated segment condition.

Effectiveness of bone transport with a locking plate versus conventional bone transport for tibial defects

To investigate the effectiveness difference between bone transport with a locking plate (BTLP) and conventional bone transport with Ilizarov/Orthofix fixators in treatment of tibial defect. The clinical data of 60 patients with tibial fractures who met the selection criteria between January 2016 and September 2020 were retrospectively analyzed, and patients were treated with BTLP (BTLP group, n=20), Ilizarov fixator (Ilizarov group, n=23), or Orthofix fixator (Orthofix group, n=17) for bone transport. There was no significant difference in gender, age, cause of injury, time from injury to admission, length of bone defect, tibial fracture typing, and comorbidities between groups ( P>0.05). The osteotomy time, the retention time of external fixator, the external fixation index, and the occurrence of postoperative complications were recorded and compared between groups. The bone healing and functional recovery were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. All patients of 3 groups were followed up 13-45 months, with a mean of 20.4 months. The osteotomy time was significantly shorter in the BTLP group than in the Ilizarov group, and the retention time of external fixator and the external fixation index were significantly lower in the BTLP group than in the Ilizarov and Orthofix groups ( P<0.05). Twenty-two fractures healed in the Ilizarov group and 1 case of delayed healing; 16 fractures healed in the Orthofix group and 1 case of delayed healing; 18 fractures healed in the BTLP group and 2 cases of delayed healing. There was no significant difference between groups in fracture healing distribution ( P=0.824). After completing bone reconstruction treatment according to ASAMI criteria, the BTLP group had better bone healing than the Orthofix group and better function than the Ilizarov groups, showing significant differences ( P<0.05). Postoperative complications occurred in 4 cases (20%) in the BLTP group, 18 cases (78%) in the Ilizarov group, and 12 cases (70%) in the Orthofix group. The incidence of complication in the BTLP group was significantly lower than that in other groups ( P<0.05). BTLP is safe and effective in the treatment of tibial defects. BTLP has apparent advantages over the conventional bone transport technique in osteotomy time, external fixation index, and lower limb functional recovery.

Experimental and clinical studies on the reduction of bone lengthening terms at the Ilizarov Center

Introduction The list of pathological conditions that need surgical correction of bone length is very long. In the literature on the topic under discussion, it is reported that the best results are obtained by lengthening according to the Ilizarov method. But many surgeons are not satisfied with the long duration of external fixation, which requires a large number of adjustments and patient compliance. The aim of this work is a analysis of the modern technologies for limb lengthening that actually shorten the time of osteosynthesis using the apparatus for external fixation. Materials and methods Literary sources have been analyzed since the first publication on limb lengthening according to Ilizarov in 1963. The search was carried out in the databases of the RSCI, NCBI Pubmed, Medline. The developments of the employees of the Ilizarov Center are presented. Results An analysis of the literature showed that the fixation units of the apparatus, units for providing movement for distraction, compression and correction of angles have been improved. The invasiveness of the surgical intervention is minimized. Best results can be obtained using automatic lengthening. The Ilizarov Center has developed and experimentally proven methods for reducing the period of distraction and the period of fixation with the apparatus. We combined three factors: an increased round-the-clock distraction rate (2 or 3 mm) with a motorized distractor adjusted to the Ilizarov frame and fixation reinforcement along with regeneration stimulation with HA-coated intramedullary wires in our experimental and clinical trials. This technology has easily conquered a number of clinical practices in Russia, France and Serbia. Conclusion Experimental and clinical substantiation of a two- or three-fold increase in the rate of automated distraction in the conditions of intramedullary reinforcement with a bioactive implant can drastically reduce not only the time of the distraction period, but also the duration of the fixation period with the Ilizarov apparatus.

Innovative, minimally invasive and cost effective use of Ilizarov fixator in correction of a severe knee flexion deformity: A case report

Poliomyelitis is an infectious disease caused by the poliovirus, which is a member of the genus Enterovirus, belonging to the Picornaviridae family [1]. Poliomyelitis is transmitted from a patient or a symptom-free carrier through the feco-oral route. The manifestations vary from asymptomatic to the most severe forms of debilitating paralysis. Existence of poliomyelitis in ancient times is documented in the history. There are Egyptian paintings from the period 1403 to 1365 BC that depict children with deformed limbs and walking with sticks [1].

Aggressive giant cell tumour of the talus: a rare case report and challenges faced during its management

&lt;p&gt;Giant cell tumour (GCT) of the bone is a locally aggressive benign tumour that commonly occurs in the epiphyseal ends of long bones. Its occurrence in the small bones of the foot like the talus is rare. In this case report we described a case of aggressive GCT of the talus (Campanacci grade 3) in a twenty-one years old male diagnosed by the presence of a well-defined osteolytic lesion seen involving the talar body with cortical breach and soft tissue extension confirmed to be a GCT by closed needle biopsy. The patient was managed surgically by excision of the tumour mass in-toto along with the talus followed by tibio-calcaneal fusion using free fibular strut graft and Ilizarov frame. At 3 months follow up no evidence of fusion was seen and therefore secondary augmentation with a cortico-cancellous graft from the iliac crest was done to aid fusion and Ilizarov fixator was removed 6 months after the surgery. The patient at one year follow up had shown no signs of recurrence of the tumour and has a pain free, stable fused tibiocalcaneal joint with a bipedal unassisted gait. Our case report found excision of talus combined with tibio-calcaneal fusion using free fibular strut graft along with cortico cancellous iliac bone graft to have a good outcome in terms of aiding tibio-calcaneal arthrodesis and thereby providing pain relief and providing a stable foot to the patient.&lt;/p&gt;

Ilizarov Ankle Arthrodesis: A Simple Salvage Solution for Failed and Neglected Ankle Fractures.

Infection around theankle joint after fracture fixation, or septic arthritis with active discharging sinuses is often challenging to manage with conventional procedures of arthrodesis. The Ilizarov method of arthrodesis gives a better alternative for salvage in such cases. This was a retrospective study including 20 patients who were subjected to tibiotalar arthrodesis with Ilizarov method. The major pathologies included internal fixation of ankle fractures complicated by infection, posttraumatic infected ankle arthritis, and osteomyelitis. The patients were evaluated on the basis of Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. The aim of the surgery was to achieve plantigrade, stable, and painless foot with no signs of infection. A total of 20 patients were operated and reviewed at our institute. The study comprised of 15 male and 5 female patients with a mean age of 43.9years (range 33-55years). Out of 20 patients, 4 patients had complications of pin-tract infection and one had wire breakage of the forefoot ring. According to the ASAMI criteria, 17 patients had excellent bone scores and 18 patients had good functional scores. Union was achieved in all patients with resolution of infection and the mean limb length discrepancy was 1.92cm (range 1-2.5cm). The Ilizarov fixator for ankle arthrodesis provides an excellent way for strong bone fusion, infection eradication, early weight-bearing, and the added benefits of compression atthe arthrodesis site post-operatively.

Evaluation of tibial condyle fractures treated with primary Ilizarov with a modified technique

Tibial condyle fractures become more challenging when they present with damaged soft tissue. Our aim is to evaluate such fractures with Ilizarov ring fixator along with our modified technique to give better outcome.: Our study included 54 cases with proximal tibia fracture treated with Ilizarov by same surgeon and team from December 2017 to May 2021.: Mean time for radiological union was 24.37 weeks (15 to 35 weeks). Ilizarov fixator we have removed 21 days after radiological union. Functional score was calculated using two scores: Hohl and Luck score, and Lyshom’s score. 12 has excellent, 28 good, 14 were fair and no patient with poor result. Mean Lyshom’s score was 81.73. Knee range of movement in maximum patients were 0 to 110 degree. There was few complications, like, Extensor lag which got corrected with physiotherapy. Pin tract infection which healed with few dressings. Ilizarov ring fixator is an excellent option for Tibial Plateau fractures as a definitive surgery especially with damaged soft tissue. And with our modification we can achieve perfect joint alignment and early weight bearing.

Subjective and Objective Outcomes of Ankle Joint Arthrodesis with Either Ilizarov or Internal Fixation

After arthroplasty, arthrodesis of the ankle joint is the most common method to treat advanced ankle osteoarthritis. The goal of the study was to assess the subjective and objective outcomes in 2 different types of fixation for ankle joint arthrodesis. We retrospectively assessed 47 patients who had undergone ankle joint arthrodesis with fixation either via an Ilizarov apparatus (group 1) (n=21) or cannulated screws (group 2) (n=26). The outcomes were measured by: (1) the quantity of analgesics administered, (2) the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, (3) general patient satisfaction, (4) the patients' decision to undergo the same procedure given another chance, and (5) the necessity of blood transfusion during hospitalization. Data was collected at the last postoperative follow-up visit. The AOFAS scores in group 1 and group 2 patients were 73.9 ± 13 and 72.7 ± 14.3, respectively. In group 1, 17 patients (81%) were very satisfied with the results, while in group 2, 19 patients (73%) were very satisfied with the results (p=.043). Two group 1 patients (10%) and four group 2 patients (15.3%) reported that they were satisfied with the outcomes (p=.035). Two patients (10%) from group 1 and three patients (11%) from group 2 were fairly satisfied. Seventeen patients (81%) after arthrodesis with Ilizarov fixation and 21 patients (81%) after arthrodesis with internal fixation would choose the same procedure given the opportunity to choose again. In group 1 there were no patients who required blood transfusion; in group 2 one patient (4%) required blood transfusion; the difference was statistically significant (p=.039). Nineteen group 1 patients (90%) were administered an analgesic preoperatively, while postoperatively only 6 (29%) required analgesics. In group 2, 24 patients (92%) were administered analgesics preoperatively, with 8 (31%) of them still requiring analgesics postoperatively. Ankle arthrodesis patients from both group 1 and group 2 achieved good subjective and objective results of treatment. We noted slightly better results in the Ilizarov apparatus group.

Treatment of Infected Gap Non-Union of Tibia with Ilizarov Technique: A Case Report

Treatment of infected gap non-union of tibia occurring mostly after trauma and often complicated by infection is difficult to treat. Daily clinical practice in fixation, soft tissue management, and antibiotic therapy, treating infected gap nonunion of the tibia remains a problem for Orthopaedic surgeons. Management includes thorough debridement, stabilization of the fracture, and reconstruction of the bone defect. The study's goal was to evaluate the Ilizarov fixator frame's effectiveness in treating tibial gap nonunion.

Malunion of the Tibia: A Systematic Review.

Background and Objectives: Tibial malunions are defined as tibial fractures that have healed in a clinically unacceptable position, resulting in deformity such as shortening, lengthening, abnormal rotation, or angulation. These deformities can have adverse effects on patients, such as pain and gait disturbance, as well as long term development of post-traumatic arthritis. This paper seeks to highlight some of the options for surgical management of malunions and detail the strategies and approaches used to manage these complicated cases. Materials and Methods: An exhaustive search was conducted on PubMed using the key search terms “Tibial” OR “Tibia” AND “Malunion” to be included in the title. Exclusions to the search included any article with patients aged < 18 years, any nonhuman subjects, and any article not published or translated into English. Results: A systematic review of the literature revealed 26 articles encompassing 242 patients who had undergone surgical correction for tibia malunion. A total of 19 patients suffered from complications. Methods of treatment included osteotomies, with plate and screws, external fixator, angled blade plate, intramedullary nails, Ilizarov fixator, Taylor Spatial Frame, Precise nail, and total knee arthroplasty. Restoring alignment and the articular surface led to overwhelmingly positive patient outcomes. Conclusions: Tibial malunions take many forms, and as such, there are many approaches to correcting deformities. The literature supports the following radiological parameters to diagnose tibial malunion: 5–10 degrees angulation, 1–2 cm shortening, 10–15 degrees internal rotation, and 10–20 degrees external rotation. Surgical plans should be customized to each individual patient, as there are many approaches to tibial malunion that have been shown to be successful in delivering excellent clinical outcomes.

Functional and radiological assessment of complex tibial plateau fractures managed with Ilizarov fixator: a study of 60 cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tibial plateau fractures represent 1% of fractures in adults. The soft tissue envelope is in jeopardy in these fractures and can be complicated by wound dehiscence and osteomyelitis. In an Ilizarov fixator, the juxta-articular wires are placed percutaneously with minimal disruption of periosteal and endosteal blood supplies, olive wires can compress the fracture lines. The aim was to analyse the results of application of Ilizarov fixator in patients with Schatzker V and VI of tibial plateau.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted with 60 patients who sustained Schatzker V and VI type of tibial plateau fractures, of either sex, of an age of more than 18 years as a prospective observational study. 50 patients were treated with closed reduction and ligamentotaxis and 10 with mini open reduction prior to ring fixator application. They were followed up for a mean period of 15.4 months. The results were assessed in according to the criteria of Honkonen and Jarvinen (1992).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the fractures united at a mean of 13.2 weeks. 48 patients felt their knee to be fully stable and 4 patients had severe pain. All patients were able to fully extend their knee, 36 patients had a flexion of &amp;gt;130 degrees and in 24 ranged between 110-129 degrees. There were 40 excellent results, 12 good, 4 fair and 4 poor. 14 patients had pin tract infections which were treated by antibiotics, 4 patients required changing the pin.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Application of Ilizarov fixator is a useful method for early, definitive management of complex tibial plateau fractures with excellent results.&lt;/p&gt;

A new technique of hindfoot reconstruction in chronic calcaneal osteomyelitis using the Ilizarov apparatus - a case series.

Calcaneal osteomyelitis (OM) is a challenging disease. Traditional surgical management has a limited success in preservation of the foot. The surgery proposed with the use of the Ilizarov apparatus for calcaneal OM aims to preserve the function, shape, and stability of the foot. Five patients between the age of 21 and 36 years, with isolated total and subtotal calcaneal OM, were treated with this technique in Royal Jordanian Medical Services (RJMS) institutions. Complex treatment included two stages: 1) radical sequestrectomy, and fixation of the foot in a favourable position with the Ilizarov fixator; 2) arthrodesis, reconstruction of the foot in order to fill in the bone defect. The patients were followed-up in the immediate (one month) and long-term (from one to six years) periods after treatment. The infection process was arrested and no recurrence was encountered. Weight-bearing ability was recovered. The shape of the hind foot was maximally close to natural. The patients reported high satisfaction.

Management of Infected Non-union Tibia with Ilizarov External Fixator: Study on Tertiary Hospital in Bangladesh

Introduction: Infection is the most prominent cause of delayed or non-union in tibial fractures because of the bone's sensitive subcutaneous location. Ilizarov external fixator application is regarded as the best approach for treating them because of several benefits. Analysis of the role of Ilizarov fixation in infected tibial non-union was the goal of this investigation and evaluating clinical &amp; functional outcomes of infected tibial non-union. Materials and Methods: A Multicenter based non-randomized quasi-experimental prospective study was performed in Rajshahi Medical College Hospital, Rajshahi, Bangladesh. From 1st January 2015 to 31st December 2020. The study comprised a total of 61 (n=61) Tibial non-union patients treated with the Ilizarov fixator who also had an infection. ASAMI score criteria were used to evaluate the outcome. Results: The most common organism for infection was identified to be at Staphylococcus Aureus. The final follow-up showed that all but one patient had achieved union; one patient had to amputate due to infection and non-union. ASAMI score rating methodology for bone and function results rated the majority of patients as outstanding. Pin tract infections were the most prevalent problem discovered in this research. Conclusion: The Ilizarov external fixator is safe and successful for treating infected non-union of the tibia since it can offer a stable mechanical environment, bone transfer, rectify deformities, eradicate the infection, and allow patients to bear weight. Therefore, we still suggest it despite its disadvantages.

Comparative Stiffness Characteristics of Ilizarov- and Hexapod-type External Frame Constructs.

BackgroundThe Ilizarov method and fixator are clinically recognised for the treatment of fractures, limb salvage and deformity correction. There have been extensive studies determining the basic mechanism for fracture healing using this technique. It is generally accepted that circular frames optimise the mechanical environment by reducing shear strain across the fracture while maintaining axial micromotion so as to promote fracture healing. There have been several new hexapod-type frames introduced into the market over the past 20 years with little comparative research into their biomechanical properties and resultant effects on the fracture environment.Questions/purposesTo investigate the biomechanical behaviours of the TrueLok-Hex (TL-HEX) and Taylor spatial frame (TSF) hexapod-type circular external fixators with comparison to traditional Ilizarov-type (TL-Ilizarov and TSF-Ilizarov) constructs and potential performance in vivo.MethodsTesting was performed on standardised four-ring TSF and TL-HEX constructs matched by identical frames using Ilizarov threaded rod constructs for each set of components. All frames were tested under physiological levels of axial, bending and torsional loading. Load-deformation properties for each construct under each mode of loading were calculated and analysed statistically using ANOVA.ResultsUnder axial loading, the Ilizarov construct utilising TL-HEX components demonstrated the greatest rigidity followed by the Ilizarov construct using TSF components. Under bending loads, the difference in rigidity between constructs was similar but less marked. Under torsional loading, both hexapod frames were seen to be significantly more rigid than the Ilizarov constructs. Overall deformation around neutral loading was much higher in the TSF frame due to an observed significant “toe-in” laxity in the strut universal joints. The remaining deformation of both hexapod frames was similar with a higher level of TL-HEX rigidity in axial loading and a higher level of TSF rigidity in bending and torsion.ConclusionIn conclusion, both hexapod frame constructs were less rigid under axial loading but more rigid under bending and torsional loads than their comparative Ilizarov constructs. As a result of their Cardan universal joints, the TSF demonstrated greater overall planar strain due to the observed “toe-in” laxity around neutral loading while the TL-HEX, with ball-and-socket universal joints, demonstrated a minimal level of laxity. Beyond the initial deformation due to the preloaded laxity, both hexapod frames responded to loading in a similar manner. There were significant differences in the frames’ mechanical behaviour under different loading conditions but further research is required to determine whether these translate in vivo into clinical significance.How to cite this articleFenton C, Henderson D, Samchukov M, et al. Comparative Stiffness Characteristics of Ilizarov- and Hexapod-type External Frame Constructs. Strategies Trauma Limb Reconstr 2021;16(3):138–143.

Intra-articular osteotomies for medial compartment osteoarthritis: Is adding an extra-articular osteotomy worthwhile?

Background and Aims: Medial compartment osteoarthritis (MCOA) of the knee presents with varus deformity arising from the upper tibia or lower femur. High tibial osteotomies relieve pain by correcting the varus and improving the mechanical axis deviation (MAD). Closing wedge, opening wedge, and dome osteotomies are popular choices in the upper tibial metaphysis. These are all extra-articular osteotomies (EAO). Recently, attention has turned to detection and treatment of intra articular deformity arising from the knee to treat MCOA. Tibial condylar valgus osteotomy (TCVO) is an intra-articular osteotomy (IAO) which corrects the varus malalignment by elevating the medial tibial condyle and is usually fixed with a plate (Tibial condylar valgus osteotomy-plating [TCVO-P]). A second distal extra articular osteotomy, fixed with an Ilizarov fixator (tibial condylar valgus osteotomy-Ilizarov [TCVO-I]) is performed in some patients for better correction of the mechanical axis. The two groups were treated with different surgical approaches based on preoperative analysis of deformity. Hence this is a level IV study. We aimed to study the improvement in radiological parameters after TCVO in MCOA. We also compared the results between TCVO-P and TCVO-I. Patients and Methods: We performed 64 osteotomies in 55 patients over the last 7 years. 30 (33 tibiae) had a TCVO-P. 25 (31 tibiae) had a TCVO-I. The mean age in TCVO-P was 55 years, and in TCVO-I was 48 years. Results: The mean preoperative (bo) MAD was more in TCVO-I at –37.4% and improved to a mean postoperative MAD of 53.8%. TCVO-P had a lesser mean bo MAD of –7.4%, which corrected to 46.4%. MAD was better corrected by TCVO-I (P = 0.0058). Correction of medial proximal tibial angle, hip knee ankle angle, ankle joint line orientation improved significantly in both groups. The knee joint line orientation was improved by TCVO-I (P = 0.001), but not by TCVO-P (P = 0.075). Joint line convergence angle (JLCA), spine edge angle, and spine vertical distance were all significantly improved in both groups. Condylar plateau angle was not changed significantly in either group. Conclusion: TCVO is an Intra articular osteotomy which effectively corrects the varus deformity arising from the knee joint in MCOA. An isolated TCVO-P slightly under-corrects the mechanical axis. TCVO-I is better at restoring mechanical axis to beyond neutral and is better for younger patients and with intorsion deformities.