Ilizarov Technique Research Articles

Метод Илизарова при лечении детей с околосуставными переломами

Introduction Periarticular injuries in children include types I and II fractures according to the Salter-Harris classification and metaphyseal fractures. In most cases, conservative treatment is an effective method, but in some cases, surgical treatment, including external fixation, is the method of choice. Purpose Discussion of the principles of using the Ilizarov apparatus in the treatment of children with periarticular fractures of various locations, its advantages and disadvantages. Materials and methods We present the principles and features of the Ilizarov surgical techniques for treatment of children with periarticular fractures of the distal humerus, femur, radius and tibia. Discussion The methods of osteosynthesis for pediatric periarticular fractures imply transphyseal introduction of fixators that have a potential threat of iatrogenic damage to the growth plate in contrast to external fixation which performance implies that transosseous elements do not injure the growth zone, providing stable fixation of bone fragments in combination with early functional recovery of the damaged segment which is a key advantage over other methods. Conclusion The use of the Ilizarov apparatus enables to achieve the desired result in the treatment of pediatric periarticular fractures and has a number of advantages over other methods of surgical treatment.

Efficacy of PRECICE Nail in Treatment of Adult Patients With Posttraumatic Femoral Leg Length Discrepancy

Posttraumatic, limb length discrepancy in adults is a challenge to treat, and multiple treatment protocols over the years have shown varying levels of success and complications. Before the introduction of the PRECICE nail in 2011, our preferred method of limb lengthening used an Ilizarov or Taylor Spatial frame. To assess the PRECICE nail, we evaluated the accuracy and complications during treatment in a series of skeletally mature patients with posttraumatic femoral limb length discrepancy. The surgical technique along with a case series of 8 patients are described in detail. On average, the target lengthening for the PRECICE nail was 44 mm, and all patients achieved lengthening within 2 mm and complete bony consolidation. The only observed complication in our series was a broken screw 1 year after the patient started weight-bearing. The PRECICE nail demonstrated promising results and was useful for bone regeneration and consolidation without the need for additional procedures. The rate of complications was low compared with previous methods, making this device an excellent treatment option.

The efficacy of ilizarov method for management of long tibial bone and soft tissue defect

IntroductionPatients with open fracture Gustillo-Anderson grade 3 had undergone several surgical procedures, but still ended up with expose long dead bone or infected. Illizarov method was used to address long bone and soft tissue defect after re-debridement with radical resection of long dead bone or infected segment. MethodsWe included 14 patients (mean age: 30.86 ± 11.49) with non-union tibial fracture with long dead and infected bone segment who had undergone several debridement, bone grafting or spacer and soft tissue closure procedure due to open fracture of tibia grade 3. The subjects underwent re-debridement with radical resection of dead or infected bone segment followed by Illizarov method to perform bone transport procedure for bone defect filling and simultaneously restore severe soft tissue loss and bone lengthening procedure. ResultsAll subjects had achieved satisfactory results with mean docking period of bone transport 3.78 ± 0.54 months, union time at the docking side 7 (5.5–9) months. Soft tissue was covered and no recurrence of infection. Three subjects had Leg Length Discrepancy (LLD) of 1 cm, whereas the remaining had zero discrepancy. No significant pain was observed at final follow-up and 4 patients had ankle joint stiffness. ConclusionThe Illizarov method can effectively address long bone and soft tissue defects by distraction osteogenesis through bone transport procedure that filling the defect gradually without bone graft and simultaneously enhancing soft tissue closure without tertiary soft tissue procedure subsequently followed with bone lengthening procedure to correct the limb length discrepancy.

Tactics of the treatment of the purulent arthritis of the ankle joint

Purpose of the study. To develop a systematic approach to the treatment of various clinical forms of septic complications after open fractures dislocations in the ankle joint.
 Materials and methods. 36 patients were treated. Of these, 28 (78, 3%) are men and 8 (21,7%) are women of working age. The basis of surgical treatment was radical sequestrectomy – resection of articular joint surfaces and through bone osteosynthesis according to Ilizarov.
 In the postoperative period, patients received antibacterial, vascular and detoxification therapy. During dressings, the wound was flushed with antiseptics through drainage tubes. In the presence of significant necrosis of soft tissues, VAKtherapy, laser therapy, prolonged intraosseous blockade were prescribed.
 Results and discussion. Longterm results were studied in 31 (83,7%) patients. Bone ankylosis occurred in 29 (78,3%) patients, 3 (8,1%) patients in connection with the progression of the inflammatory process in the talus bone performed the second operation astragalectomy.
 Conclusion. When the inflammation of the articular surface is affected, resection of the joint with subsequent compression of the arthrodesis is necessary. The Ilizarov apparatus provides a stable fixation at the site of resection.

Dynamic Gait Parameters in Patients With Nonunion of the Tibia Following Treatment With the Ilizarov Method.

The purpose of this study was a comprehensive assessment of the dynamic parameters of gait in patients who underwent Ilizarov treatment for nonunion of the tibia. The experimental group consisted of 24 individuals treated with the Ilizarov method for nonunion of the tibia. The control group comprised 31 healthy individuals, matched for BMI, sex, and age. The dynamic gait parameters in patients and in the control group were measured with a Zebris pedobarographic platform. The treatment group and the control group showed statistically significant differences in terms of the following gait parameters: maximum force during braking nonoperated-limb (NOL), time maximum force during braking operated-limb (OL), time maximum force during braking NOL, maximum force during push-off NOL, time maximum force during push-off OL, and maximum force forefoot OL. Most of the evaluated gait parameters were bilaterally similar in patients group. The only significant differences between the operated and nonoperated limb were seen in terms of Time maximum force during push-off and Maximum force forefoot. The most pronounced abnormalities in dynamic gait parameters were observed in the forefoot (maximum force forefoot OL was 13.3% lower than in the control group, maximum force forefoot OL was 12.4% lower than in NOL). The patients treated with the Ilizarov method did not achieve a complete normalization of dynamic gait parameters, as their gait parameters did not equal those measured in the control group. The Ilizarov method for the treatment of tibial nonunion helps restore a symmetrical distribution of gait parameter values between the affected limb and the healthy limb. Patients continue to show the following abnormalities in their dynamic gait parameters after treatment: higher values maximum force during braking NOL, Time maximum force during braking OL, time maximum force during braking NOL, maximum force during push-off NOL, contact time forefoot NOL, contact time midfoot NOL, contact time heel NOL and smaller values of time maximum force during push-off OL.

The Ilizarov Fixator: A Treatment for Relapsed Clubfoot, an Observational Study

Purpose: The Clubfoot, or the Congenital Talipes Equinovarus, is the most common congenital orthopedic disease, with 1 or 2 cases reported per 1000 live births. The purpose of this study is to assess the efficacy of the treatment of the complex equinovarus deformity of the feet, using the Ilizarov technique. Materials and Methods: In a prospective case series study from January 2012 to April 2016, 32 patients (35 feet) with rigid and complicated club feet have been included. The Ilizarov technique was applied in order to treat the mentioned deformity. These patients had no other congenital anomalies or systemic diseases. Outcomes were evaluated using the International Clubfoot Study Group (ICFSG) scoring system. Results: All of the patients were between 8 and 14 years of age, with the mean age of 10.9 years old. The mean of preoperative ICFSG score, morphological score, functional score, and radiologic score were 21.25±7, 6.2±2.4, 13.6±3.2, and 6.8±3.6, respectively. The postoperative mentioned scores were 11.88±6.18, 3.4±1.8, 4.7±2.1, and 3.8±1.9, respectively. The difference in the ICFSG scores before and after treatment was statistically significant (P=0.001). Conclusion: The Ilizarov technique can be considered as an efficient and successful treatment for recurrent or neglected clubfoot deformities, since it has provided satisfactory results.

A study of management of nonunion of tibia by ilizarov method

: Background: FDA Panel definition of nonunion ---- "Established when a minimum of 9 months has elapsed since injury and fracture shows no visible progressive signs of healing for 3 months". Tibial nonunion is most frequently met while considering the other long bone nonunion. This is mostly due to increase in the number of tibial fractures both close and open and in high-speed Road Traffic Accident (RTA) injuries. Failure of union may be due to an inappropriate mechanical environment or infection and in some cases, there is no apparent reason. The Ilizarov method relies on distraction osteogenesis and is used not only for segmental defects, but also to complex malalignment with minimal surgery. Ilizarov technique has the additional advantage of efficient fixation, early ambulation, elimination of bone grafting with minimal complications. Ilizarov provides stability and at the same time allow micro movements with axial loading with neo vascularization due to distraction, giving an excellent biological environment for fracture healing. Methods: Sample size of twenty (20) patients fulfilling the inclusion criteria admitted to Department of Orthopaedics, Chettinad Hospital and Research Centre, Kelambakkam. Study period from to November 2020.

Evaluation of the management of tibial diaphysial fracture AO Type - 42C with locking compression plate by MIPO technique

Introduction: Fracture involving the diaphysis of the tibia especially due to high energy trauma continues to be a challenging problem in Orthopaedic surgery. Treatment of tibial diaphysial fracture has improved with the evaluation of plate and nailing technologies. Recently locking compression plating have been used with minimally invasive plate osteosynthesis (MIPO) technique with indirect reduction and percutaneous plate insertion, which reported excellent results especially in comminuted tibial shaft fractures (AO Type-42C) where IM nail were contraindicated. The purpose of this study is to analyze and discuss the outcome of comminuted tibial shaft fractures (AO Type-42C) treated with MIPO technique. Methods: This prospective (interventional) study included 19 adult male and 06 adult female patients who had high-energy closed tibial shaft fractures with varying degrees of displacement and comminution. All cases were assessed by clinical examinations and radiographs before and after surgery. Post-operative follow-up was done for a mean time of 06 months and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. Results: Most of the fractures 11(44%) united with a mean union time of 19.6±2.53 weeks. ranging from 19-21weeks. Clinical and radiological outcomes according to the ASAMI scoring system showed satisfactory results (excellent and good) in 23 patients, representing 92% of the studied group. There were no persistent limitation of the knee or ankle motions and deep wound infection. Implant failure didn’t occurred in any of the patients until the last follow-up, and none of the patients required a second major open intervention. Conclusion: The minimally invasive plate fixation with locking compression plate is an effective method of stabilization for closed comminuted tibial shaft fractures, yielding good bone alignment with minimal soft tissues injury, leading to higher union rates with good functional outcome.

Refracture after Ilizarov fixation of infected ununited tibial fractures-an analysis of eight hundredand twelve cases.

Refracture of the tibia after union is a challenging problem for the patients and the surgeons. The purpose of the current study is to present our experience in conservative management of such patients with refracture of infected ununited tibia after successful treatment by Ilizarov external fixator and bone transport. We reviewed the files of 812 patients with infected ununited tibia who were treated by debridement, corticotomy, and bone transport using Ilizarov methods in our institute between 1997 and 2017. Inclusion criteria were patients with refracture after union and removal of the Ilizarov apparatus. Twenty-two patients with 23 refracture tibia were included in the study. All the 23 tibias were treated conservatively by above knee cast that was converted to Sarmiento below knee cast after early callus formation, except in the case of upper tibial fracture that continued in above knee cast till union. Afterwards, a protective splint was used for additional twomonths. There were 19 males (86.4%) and three females (13.6%), the mean age of the patients was 38.39years, the mean time of Ilizarov external fixator application was 10.86months (range, 6-17), and the mean time of refracture after fixator removal was 2.33months. Union was achieved in 19 tibias (82.6%), with a mean time of 7.2months (range, 4-12). Complications included five cases of skin irritation that was treated by large windows in the cast and changing the casts more frequently, three cases developed DVT (deep venous thrombosis), and axial deviation occured in four tibias (17.3%). Conservative treatment of refractured tibia after removal of Ilizarov external fixator following treatment of infected non-union tibia by above knee cast is effective in achieving union. However, complications as skin irritation, DVT (deep venous thrombosis), and axial deviation can be anticipated.

Utility of Ipsilateral Medial Fibular Transport Using the Ilizarov Frame in the Treatment for Non-elderly Patients Sustaining Massive Tibial Bone Defects as a Sequela of Trauma and Infection: A Systematic Review

Introduction and Objectives. Segmental tibial bone loss from tumor, trauma, or infection is a debilitating, limb-threatening scenario where treatment principles involve aggressive resection of infected tissues usually leading to large defects requiring reconstruction. A systematic review was conducted to determine the best available evidence related to the ipsilateral medial fibular transport using the Ilizarov frame in the management of these massive tibial bone defects.
 Methods. Multiple medical online database search for articles containing the keywords: ipsilateral medial fibular transport, medial fibula transport, medialization of the fibula using the Ilizarov fixator, ring external fixator, vascularized free fibula, vascularized fibula transfer, and other related MeSH terms was done. Data was summarized to describethe mean age, bone defect, external fixator time, external fixator index, and bone and functional results using the ASAMI criteria.
 Results. Eight studies with a total of 43 patients with massive tibial bone defects treated by fibular transport using the Ilizarov methods were identified. The mean age was 25.27 years (6.5-44.4) with a mean bone defect of 13.57 cm (9.52-17). The mean length of follow-up was 37.67 months (18-70.2). The bone union rate was 100%. Mean external fixation time was 9.59 months (8.31-10.88) and external fixation index was 0.61 months/cm (0.52-0.70). The majority of patients have an excellent bone (84%) and functional (52%) results. The average rate of complication was determined at 0.74/patient (95% CI, 0.60-0.89). The most common complications include pin-tract infection (37%), residual loss of motion/stiffness of knee and ankle (35%), and pain on the transport site (21%).
 Conclusion. Ipsilateral medial fibular transport using the Ilizarov frame provides a viable alternative treatment option for the treatment of massive tibial bone defects.

Limb Deformity Correction Using the Ortho SUV Frame

Background and Objective. Limb deformity in terms of length discrepancy, angular and rotational deformities are amenable to correction using the Ilizarov method. The corrections can be achieved using the Ortho SUV Frame (OSF), a computer assisted six axes external fixator. Previous studies have reported easier and more accurate deformity correction. In this study, we report on our initial experience and treatment outcomes in using this system.
 Materials and Methods. This study is a case series of patients where the Ilizarov circular frame was applied and which the deformity correction was carried out using the OSF. Success and accuracy in correction, length of time to correct, number of revisions needed and complications were gathered from a review of medical records.
 Results. Thirty limbs in twenty nine cases were included in this report. Seventy seven percent (23/30) of the deformities were due to previous trauma. The rest were due to Blounts, infection and tumor. Correction in eighty seven percent (26/30) were achieved using the turning schedule provided by the Ortho SUV application software. Three cases required surgical removal of soft tissue interposition before further correction using the software was achieved. One case with posterior translation underwent closed manipulation. In the end all planned deformity corrections were achieved. Complications included pin tract swelling and erythema in 13% and all resolved either with oral antibiotics alone or combined with surgical release of pin sites under local anesthesia.
 Conclusion. The Ortho SUV is an effective tool to carry out deformity corrections using the Ilizarov method.

The state of the problem of fractures of the distal metepiphysis of the humerus in children and adolescents

Annotation. One of the most frequent injuries of the distal end of the humerus is the trans-condylar and supracondylar fractures of the humerus, which make up 47.5-80% of all intraarticular fractures of the elbow joint in children. Among the injuries of the distal humerus, the supracondylar and supracondylar fractures occur with the greatest frequency and is one of the most common domestic injuries in children aged 3 to 12 years. Our work is based on a retrospective analysis of the treatment of 255 patients treated in the Lviv City Children's Hospital for the period 2013-2017. 83.1% of patients were diagnosed with flexion fracture, 16.9% – flexion fracture. Transvertebral fractures of the shoulder were diagnosed in 85.5% of cases of the study array, supragingival – in 14.5%. The treatment of patients with the consequences of injuries of the elbow joint presents great difficulties and remains one of the most difficult problems in pediatric traumatology. Depending on the presence of rotational displacement and the severity of the fracture, the following types of treatment are most often used: conservative, osteosynthesis with spokes or Ilizarov apparatus. An ideal reposition and stable fixation of fragments during these injuries is necessary not only to ensure timely consolidation of the fracture, restoration of the anatomical integrity and shape of the distal humerus, but also to prevent the development of deformation in the elbow joint. Deformations of the elbow joint during supracondylar and supracondylar fractures of the shoulder, unlike deformation of another localization, cannot be adjusted and subsequently only increase and as a result can lead to impaired function of the elbow joint, and often to disability already in childhood. Thus, complicated anatomical localization of supracondylar and supracondylar fractures of the humerus in children, great technical difficulties in comparing and fixing fragments, there is a high probability of neurological and vascular disorders, both at the time of injury and during the provision of medical care, impaired function of the elbow joint determine the need for further study of this problem.

Experimental Modeling of Combined and Sequential Use of Transosseous and Intramedullary Blocking Osteosynthesis

Background. The introduction of the combined and sequential application of transosseous and intramedullary blocked osteosynthesis in limb lengthening requires an experimental study of the features of distraction regenerate. For small animals (in particular rabbits), special models are required.Aims. To develop experimental models of sequential and combined use of transosseous and intramedullary osteosynthesis in limb lengthening and substantiate their effectiveness.Materials and methods. A comparative study was carried out on 30 rabbits of the Soviet Chinchilla breed. Experimental models of sequential (EM-1) and combined (EM-2) application of transosseous and intramedullary osteosynthesis with preservation of the apparatus during the fixation period to simulate blockage were studied in the main groups. For comparison, sequential (comparison model 1 – CM-1) and combined (comparison model 2 – CM-2) use of transosseous and intramedullary osteosynthesis with dismantling of the apparatus at the end of distraction were modeled. The control was a regenerate formed according to the classical Ilizarov method. Radiographs were performed in dynamics, CT and morphological studies – at the end of the fixation period.Results. It was noted that regenerates of the same type in structure were formed in the EM-1 and CM-1 groups, as in the EM-2 and CM-2 groups. With successive methods, the spindle-shaped form of the regenerate prevailed, the formation of a pronounced periosteal component was noted. Powerful cortical plates, according to morphological studies, are formed from the periosteal and intermediate zones. With combined techniques, the cortical plates are formed thinner and predominantly from the periosteal component, the shape of the regenerate is closer to fusiform. In the comparison groups, the total time of surgical interventions was 25–50 % longer, in 50 % of cases there was a loss of length or deformation of the regenerate.Conclusions. The developed models of sequential and combined use of transosseous and intramedullary osteosynthesis for limb lengthening with preservation of fixation with an apparatus to simulate blocking have proven to be reliable in terms of fixation and easy to use on small laboratory animals..

Treatment of high-energy intra-articular fractures of tibia with Ilizarov external fixator in adults: A tertiary centre experience.

To evaluate the clinical and radiological outcomes of the Ilizarov fixator in the proximal and distal fractures of the tibia. This retrospective study reviewed 59 patients having high-energy intra-articular proximal and distal tibia fractures associated with severe soft-tissue injury, who were managed surgically with an Ilizarov fixator. The functional outcome was evaluated by using the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and the Association for the Study and Application of the Method of Ilizarov (ASAMI) Italy scoring system for tibial plateau and plafond fractures respectively. The most common mode of injury was road traffic accidents. According to the Gustilo open fracture classification, there were 16 patients with grade-I and nine with grade II open fractures. The remaining had closed fractures. According to the Schatzker classification of plateau fractures, 20 were graded as type V and 15 as type VI. According to the AO classification of plafond fractures, 12 fractures were graded as Type-43C1, 5 as Type-43C2, and 7 as Type-43C3. There was delayed union in 11 proximal and four distal fractures, all of which achieved union without additional bone grafting. In proximal fractures, according to AOFAS, out of 35, 26 had an acceptable while nine had a fair result. In distal fractures, according to ASAMI, out of 24, 16 had an acceptable while five had fair results. There were 192/448 wires in 58 patients with pin site infection; all were superficial and settled. Posttraumatic joint arthrosis was noted in nineteen. The postoperative clinical and radiological outcome indicated that primary Ilizarov external fixator is a reliable minimal invasive surgery and definitive fixation method for high-energy intra-articular proximal and distal tibial fractures with compromised soft-tissue. It also offers early stabilisation and painless joint motion without a high rate of complications.

100 ANNIVERSARY FROM THE BIRTH OF GAVRIIL ILIZAROV - THE GENIAL SOVIET TRAUMATOLOGIST-ORTHOPEDIC (06/15/1921)

The article analyzes the unique personality of the XX century, the outstanding Soviet orthopedic surgeonGavriil Abramovich Ilizarov. The evolutionary process of the formation and development of the Ilizarov method in traumatology and orthopedics at the domestic and world level is shown. The undeniable advantages of the external fixation system developed by Ilizarov are revealed. The design of the Ilizarov compression-distraction apparatus is considered. Being familiar with G.A. Ilizarov, the author shares his memories about him, describes the biological and mechanical features of the influence on the bone and other tissues of the Ilizarov system, which has become a classic and internationally recognized in the treatment of patients with fractures, pathological conditions of the musculoskeletal system, congenital and post-traumatic orthopedic deformities of the limbs.

A comparison of clinical, radiological, and quality-of-life outcomes of double-plate internal and Ilizarov external fixations for Schatzker type 5 and 6 tibia plateau fractures.

To compare clinical, functional, and radiological outcomes in patients with bicondylar tibial fractures treated with either double-plate or Ilizarov external fixation. Patients with Schatzker type 5 and 6 tibial plateau fractures who were treated with double-plate (Group O) and Ilizarov external fixations (Group E) between March 2012 and April 2018 were selected. Demographic data and preoperative, intraoperative, and postoperative variables were analyzed and compared. In the last follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Knee Society Score-Knee (KSS-Knee), KSS-Function (KSS-F), and Short-Form Health Survey (SF-36) were used to measure clinical and functional outcomes. Treatment costs and complication rates were also recorded and compared. A total of 64 patients (43 men and 21 women) were included in the study (group O: 36, group E: 28). WOMAC, KSS-F, KSS-Knee, and OKS scores were similar between the two groups (P > 0.05). The role limitations due to emotional problems, emotional well-being, and social functioning domains of SF-36 were higher in group O (P < 0.001). Three (8.3%) deep infections occurred in group O, whereas no deep infection was observed in group E (P = 0.035). The treatment cost was higher in group O (P < 0.001). In bicondylar tibial plateau fractures, functional outcomes of ORIF and Ilizarov method milar were sibut, role limitations due to emotional problems, emotional well-being and social functioning domains of SF-36 score were higher in ORIF group. However, Ilizarov method is more cost-effective and related with lesser complications.

Bone transport over the nail vs Ilizarov method in the treatment of posttraumatic defects of the femur and tibia

Relevance. From the point of view of using the advantages of both external fixation and internal osteosynthesis, the method “Bone transport over the nail” (BTON) deserves attention.Intention: To compare the effectiveness of the BTON and Ilizarov method in the treatment of patients with post-traumatic defects of the long bones of the lower extremities.Methodology. We analyzed 24 BTON cases and 47 cases of defects replacement via the Ilizarov method. The analysis included patients with segmental defects of the tibia, femur and knee joint bone defects complicated by chronic osteomyelitis.Results and Discussion. The external fixation period in BTON group was 3 times less than in the comparison group, as was the external fixation index. In case of monolocal defect replacement, the external fixation period and external fixation index in the BTON group was 4 times less than in the Ilizarov defect replacement group. With bifocal replacement of the defect, the external fixation period was 2.5 times less, and the external fixation index was 2 times less. BTON interventions were associated with complications in 31 cases (129.2 %) vs 82 cases for the Ilizarov method (174.5 %). The most pronounced decrease (3 times) was noted for cases of transosseous elements inflammation.Conclusion. The “Bone transport over the nail” technique reduces the external fixation period by an average of 3 times. This facilitates management of the outpatient phase and reduces the number of complications, especially the pin-tract infection. Cable technique combined with an orthopedic hexapod allows bifocal replacement of extended defects of the distal femur and knee joint applying the apparatus only to the lower leg. Risks of jamming the transported bone fragments by the intramedullary nail are thus excluded. To avoid breaking the traction cable, only designated devices should be used.

Tibial fibrous dysplasia in children treated by Ilizarov technique – a review of treatment options

Fibrous dysplasia is a pathological condition, where normal medullary bone is replaced by fibrous tissue and small woven specules of bone. Fibrous dysplasia can occur in epiphysis, metaphysis or diaphysis. Occasionally, biopsy is necessary to establish the diagnosis. We present a review of operative treatment using the Ilizarov technique.

Ilizarov method in treatment of neurological foot deformities

Introduction Diseases related to the lesions of upper or lower motor neurons, such as spina bifida, myopathy, and residual polio, often cause severe deformities of the foot and ankle. The treatment goal is to convert a deformed and rigid foot into a plantigrade foot. Matherial and method We treated 51 neurological feet from 2001 to 2018 with the Ilizarov method. They were polio outcomes in 27 cases, 17 feet were affected by spina bifida, 6 other patients had Charcot-Marie-Tooth disease. Results Results were assessed by comparing appearance and function before and after surgery described by Dimeglio, and modified by Dong Y.L. et al. Before surgery, there were 33 moderate and 28 severe deformities (average preoperative scores, 6.3). The mean time required to correct a deformity was 37.1 days (range, 22–58 days) and the mean time for stabilization was 67.2 days (range, 45–98 days). At latest follow-up (mean 7.42 years, from 13 month to 16 years), clinical outcomes and patient satisfaction were considered acceptable. 28 patients achieved an excellent outcome and 21 patients had a good outcome, two feet were classified as having a poor result. Nearly 86 % of patients (44 patients) were satisfied with their outcomes and replied they would repeat their procedure. Complications include infection in 15 % of K-wire tracts, Dysesthesia in 5 cases, superficial necrosis in 3. One patient developed knee contracture. 2 patients were re-operated with V osteotomy. Conclusions The Ilizarov method represents a great resource in the treatment of severe neurological deformities of the foot.

Neglected сlubfoot treated by Ilizarov and Ponseti methods

The Ponseti method has revolutionized clubfoot treatment. Though completely neglected clubfeet are now rare, partially or incompletely and improperly treated feet are not uncommon. Relapses after successful correction may occur due to non-compliance with bracing. In scarred soft tissues due to previous surgery, soft tissue distraction using external fixation helps achieve correction. The Ilizarov fixator permits us to follow the Ponseti protocol, using correction methods that may either be constrained or unconstrained by hinges. Applying force vectors perpendicular to the moment arm allows us to correct the еquinus without damaging the ankle joint. All of the above is possible when the talus is round. Full correction of the deformity is possible. However, longterm follow-up of these patients has revealed stiffness of the ankle setting and frequently with tibio-talar osteophytes anteriorly. They are probably a reaction to excessive pressure developed in the joint due to the tight soft tissues. Hence the author has now added a mild shortening of the tibia and fibula to reduce soft tissue tension, rather than resorting to further soft tissue releases through scarred tissues. This allows faster correction with the Ponseti-Ilizarov protocol and allows good ankle range of motion to persist.