Ilizarov Ring External Fixator Research Articles

Treatment of Severe Knee Flexion Contracture After Below Knee Amputation Using Hinged Ilizarov Ring External Fixator

Flexion contracture of the knee is a common complication found after Below Knee Amputation (BKA). This condition is caused by muscle imbalance and prolonged stump malpositioning after BKA. Acute surgical correction of this deformity associated with high rates of complications.A 39-years-old man with chief complaint flexion contracture after BKA 3 months before. Physical examination showed flexion contracture deformity with knee range of motion at 90° to 120° with no possibility of further knee extension. This condition prevented him to use prosthesis and start walking exercises. Gradual correction of flexion deformity was performed using hinged Ilizarov ring external fixator with the rate of distraction was 1mm/day to prevent soft tissue and neurovascular complications. After 90 days of distraction, full extension of the knee joint was achieved with no complications.Gradual correction of knee flexion contracture using hinged Ilizarov device greatly reduced the complications risk of acute deformity correction with open surgery. This technique provides more advantage of minor operative trauma with a gradually controlled correction, permitting the soft tissue to regenerate, thus lowering the risk of neurovascular complications.

To asses the union time and pin track infection rate in ilizarov fixator using the Russian and rancho hybrid fixation technique

Introduction: The treatment of complex proximal tibial fractures with ilizarov external fixators is slowly gaining more popularity and acceptability in traumatology, complex tibial plateau fractures pose a significant risk of soft tissue problems, edema and compartment syndrome, its management throws a great challenge. These fractures were treated with ilizarov external fixators. Materials and Methods: The prospective study was conducted in JSS Medical College and Hospital over a period of April 2016 to September 2017. A total of 30 patients who were treated with ilizarov ring external fixator for schatzkers type V and VI tibial plateau fractures were included in the study, each patients were randomly assigned to be treated with two methods, the Russian technique and the Rancho hybrid fixation technique, these patients were followed up and their data with regard to fracture union time and pin tract infections were collected in a Microsoft excel and the results were scrutinised. Results: There was a predominantly male population and the road traffic accidents was the most common followed by self-fall, The mean union time was 18.27+_1.79 weeks in the Russian technique and 23.47+_2.72 weeks in the rancho hybrid system the union time was assessed using the RUST criteria and The Rancho technique pin tract infection rate was 20% and it was 26.67% in the Russian technique, the incidence of pin tract infection was even though a little higher in the Russian technique the difference was not statistically significant (OR1.45(0.26-8.1)p0.5) the pin track infection was graded using the checkers and buns. Conclusion: the ilizarov Russian technique fares over the rancho hybrid fixation technique in achieving union earlier by enhancing the micromotion at the fracture site being a less rigid construct. Keywords: Ilizarov fixator, Russian technique, Rancho technique, Schatzkers type V and VI fractures, Union time, Pin tract infections.

Acupoint puncture combined with Ilizarov technique for the treatment of elderly paitents with knee osteoarthritis

To explore the clinical effect of acupoint puncture combined with Ilizarov technique in the treatment of knee osteoarthritis in the elderly. From March 2015 to February 2016, 76 patients with primary knee osteoarthritis were treated with tibial osteotomy acupoint puncture grouop and Ilizarov technique anatomical puncture group, including 24 males and 52 females, aged 56 to 75 years old with an average of 61.4 years old, and a course of 3 to 17 years with an average of 5.2 years. Among them, 38 cases were treated with external fixation of acupoint puncture needle and 38 cases were treated with external fixation of anatomical puncture needle. Preoperative full-length X-ray of both lower limbs showed tibial varus deformity, narrowing of medial knee joint space and enlargement of lateral knee joint space. The force line of the affected knee and lower limb was moved inward by body surface measurement, and the KSS knee function score was decreased. Symptoms included medial knee pain, flexion and extension, and conservative treatment for more than 2 years. The lower limb force lines of both groups were corrected and the osteotomy ends healed well. No nonunion of osteotomy, inadequate correction of lower limbs or recurrence of deformity were found. Seventy-five patients were followed up for 3, 6, 12 and 24 months after operation. There was no significant difference in knee joint mobility between the two groups before operation and on 6, 12, 24 months after operation(F=1.346, P>0.05). There were significant difference in KSS pain and total score between the two groups at 3 months after operation, acupoint puncture group was better than anatomical puncture group(P<0.05); there was no significant difference in KSS score at 12 months after operation(P>0.05). The acupoint puncture group formed a potential acupuncture effect in the acupoint area by continuously tightening the steel needle on Ilizarov ring external fixator during the post-operative adjustment. Within three months after wearing external fixator, the knee pain symptoms of knee osteoarthritis were relieved rapidly, continuously and effectively, which was significantly better than that of the anatomical puncture group.

Accordion technique in the treatment of tibial delayed union or nonunion

Objective To assess the clinical curative effect of accordion technique in the treatment of tibial delayed union or nonunion. Methods From February 2016 to December 2017, data of 11 patients with tibial delayed union (n=8) or non-union (n=3) who had been treated by accordion technique with an Ilizarov ring external fixator were retrospectively analyzed. 10 males and 1 female were included in our study, with an average age of 41.9 years (range, 21-63 years). There were 5 cases of docking site delayed union after Ilizarov transport for chronic tibial osteomyelitis. There were 3 cases of fracture site delayed union after external fixation for open tibia comminuted fracture. There were 3 cases of nonunion after tibia closed fracture, including 2 cases who had hybrid external fixation treatment, and 1 case who had conservative treatment. All the cases received accordion technique using Ilizarov ring external fixators. First, gradual compression at the fracture site was conducted until the bony contact was seen on a radiograph. After bony contact, compression was continued at a rate of 0.85 mm/d for a week, followed by distraction of 0.85 mm/d for 2-3 weeks. Afterward, a second compression was conducted using same rate and time with the distraction procedure. And there was a 7-day latent period between compression and distraction. One or two cycles of compression-distraction were needed before union was present radiographically. Results Bony union was obtained in all 11 patients after a mean time of 5.4 months (from 3 to 9 months). The mean follow-up for the 11 patients was 15.2 months (from 11 to 29 months). The mean duration of the accordion technique treatment was 50.2 d (range, 35-67 d). The accordion technique was used 1 time for 8 patients, and 2 times for 3 patients. The mean duration of bone consolidation was 114.9 d (range, 64-239 d). According to Paley evaluation criteria, osseous results were excellent in 8 cases, good in 3 cases, with a good to excellent rate of 100%(11/11); functional results were excellent in 7 cases, and good in 4 cases, with a good to excellent rate of 100%(11/11). Conclusion The accordion technique is a minimal invasive, safe and reliable treatment program for tibial delayed union or nonunion. Key words: Tibial fractures; Fractures, ununited; External fixators

Limited orthopaedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis

To summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method. From the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017, 629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed. Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years (mean, 47.1 years). Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in 39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator. Of the 629 cases, 481 cases were less than 50 years old (76.47%), accounting for 144 cases between 51 and 65 years old (22.89%). Among them, 495 cases (78.70%) were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformities, the results were excellent in 23 cases, good in 20 cases, fair in 12 cases, and poor in 2 cases, with an excellent and good rate of 75.44%. The 2 patients with poor effectiveness were reoperated to improve their function. Limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis can effectively correct deformities of lower limbs, improve function, delay the disability aggravated by decay, and avoid serious complications.

Accordion technique used in treatment of hypertrophic nonunion

Objective To evaluate the therapeutic effects of the accordion technique used in external fixation for long bone hypertrophic nonunion. Methods From August 2013 to December 2015, 13 patients with hypertrophic nonunion were treated by the accordion technique (distraction, compression and re-distraction) used together with an Ilizarov ring external fixator or a monolateral external fixator. They were 10 males and 3 females with an average age of 44.6 years (from 18 to 63 years). The nonunion occurred in the middle femur in 5 patients, in the femoral supracondyle in one, in the tibial diaphysis in 4, and in the distal tibia in 3. The procedure was performed with a preassembled external fixator without open surgery or bone graft. The pathological sites were gradually distracted (0.25 mm/day) from the seventh day postoperatively. In case of deformity, correction was conducted to restore the alignment. At the same rate of distraction, compression was started after the equal length was achieved and next followed by distraction. The frequency of cycle depended upon the callus observed in the X-rays. Results The mean follow-up for the 13 patients was 19 months (from 10 to 38 months) after removal of the external fixator. All the cases of hypertrophic nonunion obtained bony union after a mean duration of 7.5 months (from 5 to 13 months). No nonunion or deformity recurred during the follow-up. The complications such as pin-site infection (in 4 cases) and mild Achilles's tendon contracture (in 2 cases) were prevented or treated by careful nursing and rehabilitation. Conclusion The accordion technique together with an external fixator is a reliable and effective treatment for hypertrophic nonunion. Key words: External fixators; Bone regeneration; Fractures, ununited; Accordion technique

Combined free anterolateral thigh flap and tibial bone transport for resurfacing large segmental bone and soft tissue defect of lower extremities

Objective To investigate the clinical efficacy of free anterolateral thigh flap transport combined with tibia bone transport in reconstruction of large segmental bone and soft tissue defect of lower extremities. Methods This retrospective case series review included 27 patients sustaining large segmental bone and soft tissue defect of lower extremities admitted between August 2006 and April 2016. There were 22 males and 5 females, with a mean age of 36 years (range, 16-56 years). Eleven patients were identified with Gustilo ⅢB type open injury, 14 Gustilo ⅢC type open injury, and 2 large bone and soft tissue defects after internal fixation of the closed lower extremity fractures. Size of soft tissue defect was 10.0 cm×5.5 cm-21.0 cm×10.0 cm. Size of the flaps was 13.0 cm×7.5 cm-23.0 cm×11.0 cm. Length of bone defect was 5.5~18 cm and length of bone transport was 6~21 cm. Anterolateral thigh flaps were employed for limb salvage. After wound healing, bone transport with the use of an Ilizarov ring external fixator was done to treat tibial bone defect. Flap survival, wound healing time, bone transport time, bone healing index and time of external fixator removal were recorded. Mineralization of regenerate bone was assessed using the bone healing index. Results were evaluated using the Paley scoring system. Results Mean follow-up period was 4 years (range, 1-8 years). All flaps survived and the wounds were healed without ulceration or infection. Mean time for wound healing was 4.5 months (range, 1-18 months). Time interval between wound healing and bone transport was 1-4 days (mean, 1.5 months). Mean bone healing index was 55 days (range, 45-65 days), demonstrating good bone mineralization. Mean time of external fixator removal was 24.5 months (range, 10-39 months). Shape of the tibia was satisfied. All patients were able to ambulate without use of an aid. According to the Paley scoring system, results were excellent in 21 patients and good in 6 patients. Conclusion Combined free anterolateral thigh flap and tibial bone transport provides enough bone and soft tissue and satisfactory recovery of limb function and morphology, indicating an effective treatment for large segmental bone and soft tissue defect of lower extremities. Key words: Surgical flaps; Ilizarov technique; Tibial fractures; Soft tissue injuries; Bone defect

Safe Cosmetic Leg Lengthening for Short Stature: Long-term Outcomes.

It is well known that limb lengthening is performed to treat limb-length discrepancies resulting from congenital anomalies and developmental problems. However, few studies discuss lengthening for cosmetic purposes. The current authors conducted a prospective study with long-term follow-up. From July 2002 through June 2007, 133 patients requested that their height be increased. Fifty-two were approved to undergo limb-lengthening surgery. Two were lost to final follow-up, leaving 50 in the study group. For all patients, the Ilizarov ring external fixator was applied with a maximum-stability technique that achieved frame stability and allowed patients to ambulate with a walker from the first week postoperatively. The method requires close follow-up for early detection of problems. Physiotherapy improved ankle function and prevented plantar flexion deformity, which can occur during lengthening. Excellent final outcomes were achieved in all patients except one, who required additional surgery. The Ilizarov device is a safe tool for limb lengthening in individuals of short stature when applied with the authors' maximum stability technique. To the authors' knowledge, this is the first article on this topic to report long-term results (minimum 5-year follow-up for all patients). Many factors influence the outcome of lengthening surgery performed with Ilizarov devices: the material of the rings, the use of a hybrid technique combining pins and wires, the diameter and number of pins over each bone segment, the size of the rings around the limb, the surgical technique for pin insertion, and the use of hydroxyapatite-coated pins or regular stainless pins.

Simultaneous femoral and tibial lengthening in combined congenital complete fibular hemimelia and congenital short femur using Ilizarov ring external fixator

PurposeThe combination of fibular hemimelia with congenital short femur worsens the limb length discrepancy which requires extensive femoral and tibial lengthening. Patients and methodsEight patients having unilateral lower extremity shortening presented to the National Institute of Neuromotor System, Egypt, between September 2008 and September 2010 and underwent single session femoral and tibial lengthening using Ilizarov ring external fixator technique.Consolidation of the femoral and tibial required length gain was evident in the radiographic follow-up. ConclusionExtensive limb length discrepancy can be managed by simultaneous femoral and tibial lengthening. Level of evidenceThe study is type IV clinical evidence.

English

ABSREACT: BACKGROUND: Tibial plateau fractures are common injuries of the proximal tibia which vary in severity from minimally displaced stable injuries to high energy complex fractures. The emphasis in treating theses fractures are anatomical restoration of fracture surface repair of soft tissue injury. Rigid fixation to obtain a stable painless knee with normal range of motion. METHODOLOY: 60cases of tibial plateau fractures treated by various modalities were studied from June 2011 to June 2013 at our institution and followed for minimum of 6 months. The functional evaluation of knee joint graded by modified Hohl and Luck criteria. 33 patients underwent PCCS fixation. 3patient underwent ORIF with BP. 21 patients underwent ORIF with BP and bone graft 3 patient was treated with Ilizarov ring external fixator. RESULTS: The selected patients were evaluated clinically and radiologically. The indicated fractures treated as per the Schatzker’s types. Accordingly with CRIF and percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting and external fixator were used. We were able to achieve 50% of excellent result, 40% of good result (overall 90% acceptable results) with our standard surgical care using various fixation methods. In addition we had 10% poor results in terms of functional outcome. CONCLUSION: Surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reducing posttraumatic OA and there by achieving an optimal knee function.

Rates of Pin Site Infection during Distraction Osteogenesis Based on Monthly Observations: A Pilot Study

To assess the monthly rates of infection of individual pin sites in 7 patients during distraction osteogenesis. Five men and 2 women aged 15 to 35 (mean, 23) years underwent distraction osteogenesis for 8 tibias using the Ilizarov ring external fixator or Taylor Spatial Frame. Patients were taught to perform standard daily pin site care at home, and were evaluated monthly for pin site infection by a single observer using a standardised grading system. Of 1334 observations made on 110 pin/wire sites, there were 83 (6%) pin site infections; 44 (3%) were grade 1 and 39 (3%) were grade 2. The risk of infection was higher at half pin than wire sites. The highest rates occurred in the distal segment. Monthly evaluation of individual pin sites enables comparison between studies.

The Ilizarov Ring External Fixator in Complex Open Fractures of the Tibia

Complex open fracture of the tibia particularly with bone defect and infection is one of the major problems in orthopedic surgery. There are many available alternatives in the management of these fractures. The purpose of this study is to evaluate the results and efficacy of the Ilizarov ring external fixator in treating complex open fractures of the tibia. We treated 25 patients with complex open fracture of the tibia using the Ilizarov ring external fixator between March 1999 and February 2002. The open fractures were type IIIA, type IIIB , and type IIIC in 19, 9, and 4 patients, respectively. There were 11 patients with bone loss ranging from 3 to 9 cm (average bone loss 5 cm), and 10 patients with infection. There were 11 one-level tibial transports, 5 bone graftings at the docking site, 6 internal fixations with bone grafting because of pin tract infection. Results were divided into bone and functional categories [according to the association for the study and application of the method of Ilizarov (ASAMI) classification]. The bony results were excellent in 18 patients (56.2%), good in 4 (12.5%), fair in 3 (9.4%), and poor in 7 (21.9 %). The functional results were excellent in 7 (21.9%) patients, good in 14 (43.7%), fair in 4 (12.5%), and poor in 7 (21.9%). The Ilizarov ring external fixator is an effective a salvage procedure in the treatment of complex open fractures of the tibia as it allows for the simultaneous treatment of bone loss, infection, non-union, and deformity.

Comprehensive Treatment of Late-Onset Tibia Vara

Late-onset tibia vara (Blount disease) can be difficult to treat because of frequent morbid obesity and associated deformities, including distal femoral varus, proximal tibial procurvatum, and distal tibial valgus, that contribute to lower extremity malalignment. We present a comprehensive approach that addresses all components of the deformity and allows restoration of the anatomic and mechanical axes. Fifteen consecutive patients (nineteen lower extremities) with late-onset tibia vara were managed with this comprehensive approach. The mean age of the patients at the time of surgery was 14.9 years, and the mean weight was 113 kg. Standing anteroposterior and lateral radiographs were made preoperatively and at the time of the final follow-up. Preoperatively, the mean mechanical axis deviation was 108 mm, the mean lateral distal femoral angle was 95 degrees , and the mean mechanical medial proximal tibial angle was 71 degrees . In all nineteen extremities, the proximal tibial varus deformity was corrected by means of a valgus osteotomy and application of an Ilizarov ring external fixator. Distal femoral varus was corrected by means of either hemiepiphyseal stapling or valgus osteotomy with blade-plate fixation in thirteen of the nineteen extremities. Distal tibial valgus was treated either with hemiepiphyseal stapling or with varus osteotomy and gradual correction with use of the Ilizarov external fixator in eleven of the nineteen extremities. After a mean duration of follow-up of 5.0 years, the mean mechanical axis deviation had improved to 1 mm (range, 20 to -30 mm), the lateral distal femoral angle had improved to 87 degrees (range, 83 degrees to 98 degrees), and the mechanical medial proximal tibial angle had improved to 88 degrees (range, 83 degrees to 98 degrees ). The mean time required for correction of the proximal tibial varus deformity was thirty-one days, and the external fixator was removed at a mean of 4.5 months postoperatively. All patients had development of one or more superficial pin-track infections (mean, 1.9 pin-site infections per patient). No wound infections, nonunions, or neurovascular complications occurred. Eighteen of the nineteen extremities were pain-free at the time of the final follow-up. This comprehensive approach allowed restoration of the mechanical and anatomic axes of the lower extremity in patients with late-onset tibia vara, resulting in a resolution of symptoms as a result of normalization of the weight-bearing forces across the knee and ankle. We believe that this approach will decrease the risk of early degenerative arthritis of the knee.

Complications of ring fixators in the foot and ankle.

The current review reports the author's 12-year experience with the Ilizarov ring external fixator for the treatment of foot and ankle disorders. The complications caused by the use of this apparatus also will be presented. In the beginning, the complications were attributable to inexperience and the lack of literature available at that time (1987); afterward, the complications were attributable to excess of confidence and the belief that the external fixator could be the universal solution for all patients. The current review has two main purposes: to show the more frequent complications that arise during the use of the external fixators, and to present methods on how to prevent the complications and how to manage them once they occur. The majority of complications presented in the current review are related directly to the use of the external fixator. These complications could be called minor complications that frequently are seen during treatment. However, there are major complications that can be avoided with adequate application and control of the external fixator during treatment.