Ilizarov Technique For Treatment Research Articles

Preliminary study of Ilizarov technique in treatment of lower limb deformity caused by achondroplasia

To investigate the surgical method and preliminary effectiveness of Ilizarov technique in the treatment of lower limb deformity caused by achondroplasia. The clinical data of 38 patients with lower limb deformity caused by achondroplasia treated by Ilizarov technique between February 2014 and September 2021 were retrospectively analyzed. There were 18 males and 20 females, the age ranged from 7 to 34 years, with an average of 14.8 years. All patients presented with bilateral knee varus deformity. The preoperative varus angles was (15.2±4.2)°, and knee society score (KSS) was 61.8±7.2. Nine of these patients underwent tibia and fibula osteotomy, 29 cases underwent tibia and fibula osteotomy and bone lengthening at the same time. Full-length bearing position X-ray films of bilateral lower limbs were taken to measure the bilateral varus angles, analyze the healing index, and record the occurrence of complications. KSS score was used to evaluate the improvement of knee joint function before and after operation. All 38 cases were followed up 9-65 months, with an average of 26.3 months. Needle tract infection occurred in 4 cases and needle tract loosening occurred in 2 cases after operation, which were improved after symptomatic treatment such as dressing change, Kirschner wire change, and oral antibiotics, and no neurovascular injury occurred in all patients. The external fixator was worn for 3-11 months after operation, with an average of 7.6 months, and the healing index was 43-59 d/cm, with an average of 50.3 d/cm. At last follow-up, the leg was 3-10 cm longer, with an average of 5.5 cm. The varus angles was (1.5±0.2)° and the KSS score was 93.7±2.6, which significantly improved when compared with those before operation ( P<0.05). Ilizarov technique is a safe and effective method for the treatment of short limb with genu varus deformity caused by achondroplasia, which can improve the quality of life of patients.

Application of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique for thumb defect

To investigate the effectiveness of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique in treatment of thumb defect. Between February 2017 and June 2019, 6 patients with traumatic thumb defects were treated with double osteotomy and lengthening of proximal phalanx and metacarpal by Ilizarov technique. There were 5 males and 1 female. The age ranged from 28 to 57 years, with an average of 41.5 years. There were 3 cases on the left side and 3 cases on the right side. All patients were admitted to the hospital in emergency department after injury, and the stump of the thumb was trimmed and sutured. The osteotomy plane was the distal part of the proximal phalanx in 4 cases and the interphalangeal joint in 2 cases. The interval between injury and osteotomy was 20-245 days (median, 34.5 days). After minimally invasive osteotomy and placement of a semi-circular external fixator, the lengthening began on the 5th day. The proximal phalanx and metacarpal were lengthened by 0.5 mm every day, once every 12 hours. The thumb of the affected side was distracted to the middle of the distal phalanx of the healthy thumb, and the fixator was removed after the bone healed. The distraction time was 14-23 days, with an average of 18.8 days. The osteotomies were healed with healing time of 91-147 days (mean, 120.2 days). The total distraction length of the proximal phalanx and metacarpal was 1.40-2.25 cm, with an average of 1.86 cm; healing index was 51.0-72.2 days/cm, with an average of 64.9 days/cm. All patients were followed up 5-12 months (mean, 8.2 months). At last follow-up, the two-point discrimination was 5.3-8.5 mm with an average of 6.98 mm. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the score was 10-14, with an average of 12.5. Among them, 4 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. All patients were satisfied with the function and appearance of thumb after operation. The Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score was 2.3-9.1, with an average of 6.1. The double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique is an effective method for the treatment of thumb defects.

Treatment of rigid congenital clubfoot with Ilizarov technique in older children

To investigate the effectiveness of Ilizarov technique in treatment of rigid congenital clubfoot in older children. A clinical data of 55 patients (69 feet) with rigid congenital clubfoot (Diméglio grade Ⅳ) between September 2005 and September 2015 were retrospectively analyzed. There were 33 boys and 22 girls with an average age of 11 years (range, 6-14 years). There were 41 cases of unilateral clubfoot and 14 cases of bilateral clubfeet. The degree of foot deformity was rated as fair in 24 feet and as poor in 45 feet according to International Clubfoot Study Group (ICFSG) score before operation. Sixty-nine feet were treated by Ilizarov external fixator combined with limited soft tissue release, and 21 feet were combined with individualized V-shaped osteotomies. All patients were followed up 2-10 years ( mean, 4.2 years). The incisions healed well after operation. Five cases of needle tract infection occurred and were cured by local dressing change. The effectiveness was excellent in 39 feet, good in 21 feet, and fair in 9 feet according to ICFSG score, with the excellent and good rate of 87.0%. During the follow-up, X-ray films showed that no blood supply disorder or necrosis of talus, scaphoid, cuneiform, metatarsal, calcaneus, and cuboid occurred. No osteomyelitis occurred. Ilizarov technique combined with limited soft tissue release or V-shaped osteotomy for the older children with rigid congenital clubfeet is safe and can obtain significant orthopedic effectiveness.

Safe corridor for fibular transfixation wire in relation to common peroneal nerve: A cadaveric analysis

BackgroundPeroneal nerve impalement is a recognized complication of percutaneous placement of fibular transfixation wires by palpatory method after increase use of ilizarov technique in treatment of Tibial fractures, deformity correction and limb lengthening. The purpose of this study was to identify the relationship between the Common Peroneal Nerve (CPN) and the palpable landmark, fibular head for insertion of proximal fibular transfixation wire, safe zones in proximal tibia and percentage of fibula where nerve crosses the neck. MethodsStandard 1.8-mm Ilizarov k- wires were inserted in the fibula head of fresh 10 un-embalmed cadaveric knees. Wires were inserted percutaneously to the fibula head by palpatory technique. The course of common peroneal nerve was dissected. Distances from wire entry point to the course of the common peroneal nerve were measured post-wire insertion. ResultsThe mean distance of the common peroneal nerve from the anterior aspect of the broadest point of the fibular head was 25.10 ± 4.39 mm (range 16–35 mm). Common peroneal nerve was seen to cross the neck of fibula at a mean distance of 32.3 ± 8.53 mm (range 20–50 mm). Wire placement was found to be on average, 46% of the maximal AP diameter of the fibula head and 44% of the distance from tip of fibula to the point of nerve crossing fibula neck. ConclusionWe recommend Proximal fibula transfixation wires are safer to pass with in 2 cm from the tip of the styloid process of the fibula, Anterior half of the head of fibula, <8% of total fibular length, Ventral half of the anterior compartment to avoid injury to peroneal fan. The palpable landmark of fibula is a misinterpretation; it is just the prominent subcutaneous portion of fibula and not the styloid process of fibula which on dissection was located much posterior. Better to take fluoroscopic guidance in difficult cases where palpation of head of fibula is difficult.

Clinical research of Ilizarov technique for treatment of lower limb infected bone defect

Objective To explore the clinical efficacy of Ilizarov technique for infected-bone defect in lower extremity. Methods From January 2013 to December 2016, data of 31 consecutive patients with lower limb infected bone defect were retro-spectively analyzed. There were 23 males and 8 females, with an average age of 35.8 years (range, 5-57 years). 16 cases of infect-ed bone defect were on femur while the other 15 were on tibia. The infected bone defects were developed from blood-borne osteo-myelitis in 3 cases, from open fracture (according to Gustlio classification, Gustilo Ⅱ 8, Ⅲa 5, Ⅲb 4) surgery in 17 cases (12 cas-es after external fixation and 5 cases after internal fixation), and from closed fracture surgery of plate or intramedullary nail fixation in 11 cases. Soft-tissue defects were observed in 5 cases, including 1 femur and 4 tibia. The previous operations were performed with an average operation time of 3.2 (range, 2-5 times) and treatment duration of 9.6 months (range, 3-21 months). The operation process was one stage debridement, external fixation, combined with bone osteotomy and transportation. Bone transportation start-ed 7 to 10 days after osteotomy with a speed of 1 mm/d, and 0.25 mm/time. Healing rate and complications were recorded during the follow-up period and were assessed by Paley fracture healing score. Results The length of bone defect after debridement was 6.9 cm (range, 3-13.5 cm). There were 27 cases positive in bacterial culture, who were treated by sensitive antibiotics. The other 4 cases were negative and treated by broad-spectrum antibiotics. The bone lengthening speed was 0.76 mm/d (range, 0.56-0.86 mm/d). All bone and soft-tissue defects healed, with average bone healing time of 11.5 months (range, 6-18.5 months). All patients were followed-up for 12 to 48 months (average, 25.5 months). Pin infection appeared in 11 cases (8 cases on femur and 3 cases on tibia) who were cured by oral antibiotics, serial dressing and debridement. Axial displacement was presented in 4 cases on femur and were corrected by external fixation adjustment. No recurrent infection was observed and the limb length restored normal. Postoper-ative complications in femur were 106.3% (17/16) comparing 46.7% (7/15) in tibia. According to Paley fracture healing score, 12 cases were excellent, 14 were good and 5 were fair, yielding an excellent to good rate of 83.9% (26/31). Conclusion Ilizarov tech-nique is an effective way in the treatment of infected-bone defects. The complication rates on femur observed in this study were slightly higher than that on tibia. Key words: Ilizarov technique; Femur; Tibia; Infection

Effectiveness of Ilizarov technique in treatment of clubfoot after burns

To investigate the effectiveness of Ilizarov technique in treatment of the clubfoot after burns. Between March 2012 and February 2017, 12 patients (17 feet) with clubfoot after burns were treated with Ilizarov technique. There were 10 males (14 feet) and 2 females (3 feets) with an average age of 38 years (range, 18-52 years). There were 3 cases of left foot, 4 cases of right foot, and 5 cases of both feet. According to the Qin's classification of clubfoot deformity, there were 5 feet of degreeⅠ, 9 feet of degreeⅡ, and 3 feet of degree Ⅲ. All clubfeet were completely corrected without local skin necrosis, needle tract infection, or acroanesthesia. All patients could walk with a heavy load. Pationts were followed up from 4 months to 3 years (mean, 10 months). At last follow-up, according to the International Clubfoot Study Group (ICFSG) score, the effectiveness was rated as excellent in 7 feet, good in 7 feet, and fair in 3 feet, with the excellent and good rate of 82.4%. Using Ilizarov technique can gradually correct the clubfoot deformity with the advantages of minimal invasion, safeness, and simpleness.

Ilizarov technique for treatment of large tibia bone defect combined with soft tissue defect

Objective To explore the feasibility of Ilizarov technique in managing large tibia defects combined with soft tissue defects.Methods A total of 24 patients with large tibial defects combined with soft tissue defects caused by compound open tibial fractures were fixed with Ilizarov technique from September 2003 to September 2010.All patients belonged to open tibial fractures,including 20 patients with Gustilo type Ⅲ B and four with Gustilo type Ⅲ C.After debridement,the soft tissue defect areas was 10 cm ×6 cm and the bone defect was(8 ±4)cm.Fifteen patients with tibial defects ＜5 cm were treated with one stage debridement,fibula resection and tibial defect end compression.The other nine patients with tibial defect ＞ 5 cm were managed by one stage debridement,bone transport and bone lengthening.Then,15 patients were treated with one stage debridement,wound closure or wound reduction,bone grafting treatment and second stage cleansing of the incarcerated skin and fracture end.Results All patients were followed up for average 14 months(10-24 months),which showed reconstruction of the bone defects,restoration of the limb length,fracture healing and less than 2 cm difference between health limb and contralateral limb.One patient experienced common peroneal nerve palsy after operation,but recovered three months later.Of all,19 patients recovered without extra surgery,three restored with skin graft and two received skin flap.Conclusion Ilizarov technique is an effective option for treating the tibial defects combined with soft tissue defects at one stage. Key words: Bone defect; External fixation; Ilizarov technique; Tibia

Ilizarov Technique in Treatment of Congenital Hand Anomalies

An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities.