Ring Fixator Research Articles

Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study.

Aims and objectivesTo examine clinical and functional outcomes in patients with intra- and extra-articular distal tibial fractures treated definitively by Ilizarov fixation.Materials and methodsPatients with tibial fractures extending within 1 Müller square of the ankle joint were identified from our Ilizarov database over a 5-year period. Data on treatment and outcome were assembled from this database and supplemented by a review of patient records. General measures of health–related quality of life and limb-specific functional outcome scores were recorded. Adverse events were documented according to Paley's classification.ResultsOne hundred and sixty-eight patients with 169 fractures were identified, 28% were open and 63% intra-articular. One hundred and sixty-five (98%) of the fractures united, two following bone grafting in their original frames, at a median of 166.5 days (range 104–537). Three patients with nonunions united with further treatment. One patient (an end-stage diabetic) elected to undergo amputation following multiple early complications during treatment. Closed fractures united more rapidly than open (median 157 vs 183 days; p = 0.005) and true Pilon (43C3) fractures took longer to unite than other fractures (median 157 vs 177 days; p = 0.01).Sixty-seven percent of patients completed functional outcome scores. Sixty-two percent reported good or excellent ankle scores at more than 6 months post frame removal, 38% fair and 10% poor. Patients with intra-articular fractures reported significantly worse ankle scores than those with extra-articular injuries. General measures of health-related quality of life (EuroQol-5D) revealed significant ongoing effects despite good clinical outcomes.ConclusionThis study demonstrates a high union and low serious complication rate, suggesting that external ring fixation is a safe and effective treatment for these injuries.How to cite this articleGiannoudis VP, Ewins E, Taylor DM, et al. Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr 2021;16(2):86–95.

Surgical Ventricular Reconstruction Eligible for Late Assist Device Implantation

In patients with ischemic cardiomyopathy and left ventricular aneurysm formation who are symptomatic despite optimal medical therapy, it is challenging to determine whether surgical ventricular reconstruction, heart transplantation, or left ventricular assist device (LVAD) implantation is the treatment of choice. This report describes the concept of surgical ventricular reconstruction with a specially prepared LVAD fixation ring to facilitate subsequent LVAD implantation if required. In the patient reported in this case, endoventricular circular LVAD ring plasty sufficiently reduced the ventricular volume, normalized the left ventricular geometry, and subsequently led to an improvement of left ventricular ejection fraction.

A Novel technique of three-ring Ilizarov fixator frame in gap non-union of tibia

IntroductionGap non-union of tibia occurring mostly after trauma and many times complicated by infection, is a difficult problem to treat. The study aimed to assess the outcome of the three-ring construct of the Ilizarov fixator frame in the management of gap non-union of the tibia. MethodsThis retrospective study included 30 patients of gap non-union of tibia operated from April 2016 to March 2019 with a three-ring Ilizarov fixator frame and follow-up done till March 2021. The mean age was 39.27 (range 10–66) years. The results were assessed by the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. MPTA, PPTA, and LDTA after removal of the frame were also measured. ResultsOut of the total 30 cases, all the patients showed complete union. The Ilizarov fixator was kept for an average period of 11.43 months and the mean defect size was 7.17 (range 2–12) cm. All patients were followed up for an average period of 39.36 (range 24–54) months. According to the ASAMI score bone/radiological results, 27 were classified as excellent, 2 as good, and 1 as poor. Functionally 28 were graded as excellent and the remainder as good. The normal ranges of MPTA, LDTA & PPTA were also achieved in a majority (80%) of patients. ConclusionOur results after using only a three-ring Ilizarov fixator frame are almost equivalent to earlier studies and have advantages such as less weight, better patient compliance, superior radiographic visualization, easy mobilization, and reduced costs. Ilizarov ring fixator remains an excellent treatment modality for tibial non-union with a defect, regarding bone union, deformity correction, infection eradication, limb-length achievement, and limb function.

519 Outcomes of Management with Ilizarov Frames in Bone Infection: An Observational Study

Abstract Aim The successful treatment and eradication of bone infection requires a multifaceted approach and may recur even after excision if resultant bone void is not managed effectively. This paper aims to review the clinical effectiveness of antibiotic-impregnated bone void filler and current empirical antibiotic guidelines. Method We report a retrospective study of 18 patients with chronic osteomyelitis following injury or surgery managed via Ilizarov Ring Fixator (IRF). All patients were managed by IRF stabilisation procedures with debridement, microbiological sampling, and bone void filling with antibiotic-impregnated biocomposite material, in addition to culture-specific systemic antimicrobial therapy. Results Patients were followed up for a mean of 15.9 months. Infection was eradicated in 94.1% of patients in a grossly comorbid demographic. Comorbidities associated with increased risk of osteomyelitis were noted in 72.2% of patients. Anaerobic bacteria were identified in culture for four (22.2%) of the 18 patients. Conclusions We detected a higher than suspected growth of anaerobes in our samples, suggesting the need for metronidazole in empirical antibiotic treatment. This study would suggest that the use of STIMULAN® may be preferable in this National Health Service from a cost-effect perspective, as our results are comparable to those using other bone void fillers.

Two-stage fixation in the treatment of diabetic arthropathy of the ankle

Aim — to improve the results of treatment of diabetic anklearthropathies by using the final method of fixation by semi-rigid systems after arthrodesis and the use of extrafocal ring fixators (RF). Materials and methods. The authors presented own experience of treatment of 12 patients with diabeticankle osteoarthropathy. After arthrodesis and fixation with RF, the alternating osteosynthesis was performed with Scotchcast/Softcast bandages. The use of extrafocal RF of the needle-rod type in the first stage with low trauma wasadvantageous, however the time of fixation before the appearance of the fusion between the tibia and talus was significant, which led to a decrease in the rigidity of the fixation of the bone-needle system and development of inflammation at the exit of the spokes. This required the transition to other means of fixation, which would provide the possibility of functional use of the limb. The authors used Scotchcast/Softcast functional bandages, applied circularly, with stiffeners on the lateral surfaces, which allowed to carry out the supporting function of the limb. Interventions (arthrodesis of the ankle joint) were performed under multimodal analgesia. Vascular disorders required hematopoietic therapy (use of a tourniquet and administration of tranexamic acid solution) and bemiparin administrationfor microthrombosisprevention. Treatment of diabetic neuropathy and metabolic disorders was carried out by prescribing vitamin B and C, drugs Ca and vitamin D3, antioxidants. Results. The dynamics of the most examined indicators of the coagulation — anticoagulation system did not differ significantly (activated partial thromboplastic time, prothrombin time, international normalized ratio, platelet quantity). There was a tendency to shift the indicators to the recommended safe zone and even a significant decrease in the level of soluble fibrin monomer complexes (R2= 0.9494). Conclusions. The use of Scotchcast/Softcast immobilizing bandages in patients with diabetic arthropathy was safe after arthrodesis and RF fixation.This strategy allowed to restore limb capacity in the early stages of treatment, which improved the social adaptation of patients.

Удосконалення черезкісткового остеосинтезу кільцевими фіксаторами в лікуванні незрощень кісток гомілки

Актуальність. Лікування незрощень кісток гомілки є до кінця не вирішеною проблемою. Використання кільцевих фіксаторів (КФ) при цій патології може конкурувати в сучасних умовах. Однак є й недоліки. Удосконалення технології лікування КФ є перспективним напрямком для поліпшення результатів лікування цієї тяжкої патології. Мета роботи: покращити результати лікування незрощень кісток гомілки на основі вдосконалення технології використання КФ з урахуванням проблемних питань їх застосування; визначення їх ефективності. Матеріали та методи. За запропонованою методикою були проліковані 42 постраждалі з незрощеннями кісток гомілки. Спице-стрижневі апарати застосовувалися із запропонованими нами удосконаленнями — заточкою, режимами проведення і компонуванням спиць у кільці під кутами в різних площинах. У кільці, яким здійснювалося зведення остеотомованого сегмента при проведенні дистракційного остеосинтезу, допроводяться спиці на виносах для запобігання його закиданню. Напівзакрита остеотомія проводилася малотравматично і безпечно, віялоподібно долотом із поперечного розрізу до 2 см, з утворенням осколкового перелому. Втручання в зоні зіставлення відламків із пластичними елементами (обробка торцевих частин, гідроксиапатит коллапан, PRP), рання кінезотерапія, фінальне використання напівжорсткої системи зовнішньої фіксації Softcast/Scotchcast дозволили уникнути деформації регенерату і створити оптимальні умови для зрощення уламків. Результати. Були отримані наступні результати лікування постраждалих із незрощеннями кісток гомілки з використанням КФ із запропонованими нами режимами використання за оціночною анатомо-функціональною шкалою Modified Functional Evaluation Systemby Karlstrom-Olerud. Хороші результати були отримані у 20 хворих (55,6 %). У 4 хворих (11,1 %) результати оцінені як добрі з елементами помірного порушення функції. Вони становили 22,000 ± 1,323 бала. Задовільні результати були отримані у 7 хворих (19,4 %); оцінені в 28,000 ± 0,125 бала. Поганий, незадовільний результат спостерігався в 1 випадку (2,8 %); відмінний функціональний статус— у 4 (11,1 %) хворих. Висновки. З огляду на тяжкість ураження ми вважаємо такий результат обнадійливим. У зв’язку з недостатньою кількістю спостережень слід рекомендувати використання запропонованих удосконалень застосування КФ в лікуванні незрощень кісток гомілки після переломів і подальше дослідження їх ефективності.

RETRACTED ARTICLE: Failure of internal fixation of the anterior ring for unstable pelvic fractures, the experience of a single institute

BackgroundThis study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies.MaterialsFrom January 2009 to December 2018, 93 charts of patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system. Patients aging ≥ 18 years, with unstable pelvic fractures, Tile classification type B and type C pelvic fractures, combined injury of other organs that did not affect the operation and without important neurovascular damage were included. The exclusion criteria included: (1) pathological fracture, or combined with pelvic bone tumor or severe osteoporosis; (2) femoral fracture and thoracolumbar fracture; (3) open pelvic fracture; (4) Morel-Lavallée injury; (5) complicated acetabular fracture. The quality of the reduction of the anterior pelvic ring injury was evaluated on the x-ray film using the Majeed scoring system.ResultsAccording to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5 to 28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients fixed with a plate. Five patients undergoing revision surgery were followed up for 6–36 months with an average of 18 months. According to Majeed’s score at the last follow-up in the 5 patients undergoing revision surgery, there were 2 cases of excellent, 2 cases of good, 1 case of fair. The excellent and good rate reached 80%.ConclusionThe treatment of complicated unstable pelvic fractures requires performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.

Operative intervention of unstable paediatric pelvic fracture: radiological and functional assessment.

The aim of the study was to add to the literature new data regarding the evaluation of surgical fixation of challenging unstable paediatric pelvic fractures, radiologically and clinically besides recording any complications through the follow-up period. Prospective study was conducted at our hospital between 2012 and 2017 where 21 patients less than 16years with unstable fracture pelvis were surgically fixed. The method of fixation varied between the external percutaneous fixation and internal fixation. The Infix system was used in for anterior ring fixation in some cases. Patients were evaluated radiologically and functionally using the functional independence measure questionnaire (FIM) and the modified Merle d'Aubigne and Postel (MDP) score. Twelve males and 9 females were fixed with mean age of 12.5years. Motorcar accident was the main mode of trauma. Nine patients had fracture pelvis Tile's type B and 12 had Tile's type C injuries. All fractures united by 8weeks. No patients suffered from pelvic asymmetry or leg length discrepancy at a mean follow-up of 2years. The mean of FIM was 122.5 and the mean of MDP score was 16.2. Displaced unstable pelvic fractures in children need a systematic evaluation of the injury pattern. These serious fractures should be referred for anterior ± posterior ring stabilization. Promising clinical outcomes with surgical fixation can be reached with a low rate of complications. Further large-scale studies should be conducted for the calling literature.

Bone reconstruction: Subjective evaluation and objective analysis based on conventional digital X-rays – a retrospective evaluation

BackgroundVarious approaches have been used to evaluate callus stiffness in distraction osteogenesis. This assessment becomes even more critical as inadequate corticalization and premature removal of the frame lead to bending, refracture, and loss of length. This study aimed to verify the objective Pixel Value Ratio (PVR) and define an evaluation scheme to assess callus tissue development during internal and external bone lengthening. HypothesisThere are no differences between subjective parameters and objective evaluation for external and internal bone lengthening. Patients and methodsWe included 24 patients in this retrospective study, treated by distraction osteogenesis of the lower limb. Ten patients were treated with external ring fixators and 14 with intramedullary lengthening devices. The minimum distraction distance was 3cm. Callus tissue was evaluated with the PVR, using digital X-rays during and after treatment. We combined this method with subjective evaluation parameters, including the continuity, signal intensity, and the regeneration tissue's homogeneity, presented in the X-ray Evaluation System for Distraction Osteogenesis (XESDO). ResultsThe subjective evaluation showed an increase of continuity and signal-intensity between 4th postoperative weeks and complete healing with significant differences between the external and internal groups for homogeneity only after four weeks and for all parameters at 3C (p<0.05). The PVR showed an increase during consolidation with values between 0.7 and 1.0 for both groups with almost perfect interobserver agreement. Significant lower values were found in the anterior tibial cases. ConclusionPVR appears to be a practical tool for radiological evaluation of callus tissue development. In combination with the newly introduced XESDO and the surgeon's experience, these methods can be helpful for decisions during all phases of distraction osteogenesis. It is important for adapting alignment or distraction-rate, as various potential complications can be detected early. However, further studies are necessary to assess the image-based determination of callus tissue stability. Level of evidenceIII; cohort study.

Result of Ring Fixator in High-energy Schatzker Type VI Fractures of Proximal Tibia

Background: Significant articular depression, separation of both condyles, diaphyseal comminution and dissociation, and loss of soft-tissue envelope integrity are all associated with high-energy proximal tibia fractures (Schatzker VI). Over the past 50 years, there has been a lot of research on plating problems in these complicated fractures. For the care of these complex injuries, Ilizarov devised a new method (ring fixator).&#x0D; Aim of the Study: To examine the outcomes of patients who received a ring fixator for the treatment of high-energy proximal tibia fractures (Schatzker VI).&#x0D; Materials and Methods: Fourteen patients (mean age 36) were treated with the Ilizarov fixator and transfixion wires for high-energy fractures of the proximal tibia (Schatzker VI). Nine of the patients had open fractures, and five of them had significant soft tissue damage. They were all tracked for an average of 19.4 months. The result was analyzed using the criteria set by Honkonen &amp; Jarvinen (1992).&#x0D; Results: Thirteen fractures healed in an average of 14.6 weeks, with one taking six months. Twelve patients recovered complete extension, while eight others regained more than 110 degrees of flexion. All of the patients knees were stable, except one who had a minor varus deformity. Nine patients walked normally, while four had a little limp. Except for one, all of the knees exhibited an articular step-off of less than 4 mm and normal axial alignment. Six knees were found to be outstanding, five to be decent, and three to be fair. There were no instances of postoperative skin infection or septic arthritis, however, three patients did have a pin tract infection that was effectively managed.&#x0D; Conclusion: The technique is suitable for the treatment of complex proximal tibia fractures when there is substantial comminution at the fracture site as well as soft tissue damage (Schatzker VI).

Computed Tomography in Limb Salvage and Deformity Correction-3D Assessment, Indications, Radiation Exposure, and Safety Considerations.

Computed tomography (CT) is an essential tool in orthopedic surgery but is known to be a method with that entails radiation exposure. CT increases the risk of developing fatal cancer, which should not be underestimated. However, patients with bone defects and/or deformities must frequently undergo numerous investigations during their treatment. CT is used for surgical planning, evaluating callus maturation, alignment measurement, length measurement, torsion measurement, and angiography. This study explores the indications in CT scans for limb lengthening and deformity correction and estimates the effective radiation dose. These results should help avoid unnecessary radiation exposure by narrowing the examination field and by providing explicit scanning indications. For this study, 19 posttraumatic patients were included after the bone reconstruction of 21 lower limbs. All patients underwent CT examinations during or after treatment with an external ring fixator. The mean effective dose was 3.27 mSv, with a mean cancer risk of 1:117,014. The effective dose depended on the location and indication of measurement, with a mean dose of 0.04 mSv at the ankle up to 6.8 mSv (or higher) for vascular depictions. CT evaluation, with or without 3D reconstruction, is a crucial tool in complex bone reconstruction and deformity treatments. Therefore, strict indications are necessary to reduce radiation exposure—especially in young patients—without compromising the management of their patients.

Functional Outcome of Open Tibial Fracture Using Illizarov Apparatus

The better treatment for tibial fractures are very vague and difficult. Since the tibia is covered by soft tissue coverage fixing of plate becomes very difficult as it creates wound complications, mainly in case of severe fractures.In this study of 20 cases of open communited fractures of tibia with the Ilizarov ring fixator hybrid technique was used, it was found that this technique has a major advantages in treatment and management of the tibial fracture.

A Case Report on Tibial Plateau Fracture Fixed with Combination of Hybrid and Knee Spanning Fixator in Gustilo-Anderson Type 3b Injury

Tibial plateau fractures involve the intra-articular portion of the proximal tibia with or without metaphyseal extension. Here, we present the case of a 25-year-old male patient presented with Schatzker type 6 tibial plateau fracture associated with a lateral femoral condyle fracture and a vertical patella fracture fixed with a combination of hybrid ring fixator, cannulated cancellous screws, and a knee spanning frame in Gustilo-Anderson type 3 B injury. The purpose of this case report is to highlight the surgical challenges faced in such types of cases that include the Gustilo and Anderson type 3 B injury with complicated fracture morphology, the implant to be used with his current economic status, and the limited investigations available.

No more rattling: biomechanical evaluation of a hexapod ring fixator free of play.

Hexapod-ring-fixators have a characteristic rattling sound during load changes due to play in the hexapod struts. This play is perceived as unpleasant by patients and can lead to frame instability. Using slotted-ball-instead of universal-joints for the ring-strut connection could potentially resolve this problem. The purpose of the study was to clarify if the use of slotted-ball-joints reduces play and also fracture gap movement. A hexapod-fixator with slotted-ball-joints and aluminum struts (Ball-Al) was compared touniversal-joint-fixators with either aluminum (Uni Al) orsteel struts (Uni Steel). Six fixator frames each were loaded in tension, compression, torsion, bending and shear andmechanical performance was analyzed in terms of movement, stiffness and play. The slotted-ball-joint fixator wasthe only system without measurable axial play(<0.01mm) compared to Uni-Al (1.2±0.1)mm and Uni-Steel (0.6±0.2)mm (p≤0.001). In both shear directions the Uni-Al had the largest play (p≤0.014). The resulting axial fracture gap movements were similar for the two aluminum frames and up to 25% smaller for the steel frame, mainly due to the highest stiffness found for the Uni-Steel in allloading scenarios (p≤0.036). However, the Uni-Steel construct was also up to 29% (450g) heavier and had fewer usable mounting holes. In conclusion, the slotted-ball-joints of the Ball-Al fixator reduced play and minimized shear movement in the fracture while maintaining low weight of the construct. The heavier and stiffer Uni-Steel fixator compensates for existing play with a higher overall stiffness.

TIBIAL BONE NONUNION PLASTIC WITH THE USE OF MONOLOCAL OSTEOSYNTHESIS BY RING FIXATORS

Abstract. Actuality. Monolocal extrafocal osteosynthesis by ring fixators (RF) of tibial nonunion is not a generally accepted method, there are no systematic guidelines for its implementation. These issues need to be further studied. Task. Formulate situational predominant properties of RF; features of application in different condi-tions. To offer a method of nonunion plastics and features of monolocal osteosynthesis of RF and to study its efficiency. Materials and methods. The data of treatment of 16 patients with aseptic nonunion of tibia, who required complex comprehensive specialized medical care with a possible positive result (scores from 51 to 75 according to the evaluation system Non-Union Scoring System - NUSS). Implementation of monolocal extrafocal osteosynthesis of RF nonunion of shin bones after fractures was performed by us taking into account the features that distinguished it from that by fractures. The principal requirement of surgical intervention was the need to treat the center of nonunion, local stimulation of repara-tive processes. The technical features of all components of the intervention in the future were of great im-portance. The so-called blood-saving tactics were used, which were carried out using squeezing and hemostatic tourniquets, tranexamic acid. The results obtained. The results of treatment of victims with nonunion of the tibia with the use of RF in monolocal mode were as follows. Taking in consideration the severity of the lesion, we consider this result to be good. Given the insufficient number of observations, it is necessary to continue the use of the proposed method of treatment and to investigate its effectiveness. Conclusions. 1. The use of monolocal RF in patients with nonunion of tibia after fractures has the advantage of use in cases with episodes of septic inflammation in the past, extensive scarring of soft tissues, short distal fragment and osteoporosis. 2. The peculiarities of monolocal osteosynthesis of RF were the use of thick Ilizarov needles Ø 2.0 mm with their conduction at an angle of two planes. The obtained results of treatment of victims with nonunion of the tibia with the use of RF in the monolocal mode should be considered encouraging.

Narrative review of ring fixator management of recurrent club foot deformity.

Despite the widespread use of the Ponseti method for treatment of clubfeet, there continue to be a significant number of patients who present with a severe, stiff clubfoot as a result of extensive intra-articular soft tissue release or lack of access to care. In such patients, circular external fixators can be utilized for deformity correction with distraction across soft tissues, joints, and osteotomies. Ilizarov or hexapod circular fixators may be utilized according to surgeon preference. Indications for soft tissue release and osteotomies to aid in correction of clubfoot deformity with Ilizarov and hexapod fixators are not standardized and are guided by patient age, joint congruity, soft tissue suppleness, and osseous deformity. Correction time varies according to clubfoot deformity severity. Following deformity correction, external fixators are left in place for several weeks to stabilize the soft tissues and allow for osteotomy healing. Complications range from relatively minor pin tract infections that resolve with oral antibiotics to tarsal tunnel syndrome, osteomyelitis, or disabling arthritis requiring revision procedures. At Scottish Rite Hospital for Children, we prefer to correct severe residual clubfoot deformity with a hexapod external fixator. Acute correction and gradual correction via distraction are considered for each segmental deformity and utilized to efficiently correct deformity while minimizing soft tissue trauma. The purpose of this article is to summarize the relevant literature related to circular external fixator treatment of recurrent clubfoot deformity and outline our approach to the segmental deformities of the foot and ankle in this patient population.

Illizarov’s technique outcome in non-union tibial fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tibia being a superficial bone of the body and vulnerable to trauma, often becomes fractured among all long bone fractures. Tibial surface is subcutaneous most of its length so open fractures are common.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The present cross sectional study was conducted on 20 patients attending the outpatient department Of Orthopedics, Government Medical College and Hospital, Ambikapur, Sarguja (C.G) India between September 2020 to February 2021. Patients within the age group of 18-60 years, having fracture of any duration with gap non union and those having duration of fracture more than 36 weeks without bony gap were included in the study. Details of Patient’s characteristics concerning primary injury and treatment were recorded and evaluation of results were based on Paleys criteria.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;In bone/radiological results, seven were classed as excellent, eleven as good with the remainder of 2 being fair and poor each. Functionally nine were graded as excellent, nine as good and two as fair and poor each.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It was found that Ilizarov ring fixator is an excellent treatment modality for tibial non-union with infection. However the technique requires long treatment follow up. Multiple interventions may be necessary to overcome the difficulties which come across the treatment.&lt;/p&gt;

Treatment of Severe Rigid Posttraumatic Equinus Deformity With Gradual Deformity Correction and Arthroscopic Ankle Arthrodesis.

Posttraumatic ankle equinus is associated with rigid deformity, poor skin condition, and multiple prior surgeries. Open acute correction has been described using osteotomies, talectomy, and arthrodesis, but concerns exist about skin complications, neurologic alterations, secondary limb discrepancy, and bone loss. Gradual correction using a multiplanar ring fixator and arthroscopic ankle arthrodesis (AAA) may decrease these complications. We retrospectively reviewed patients undergoing correction of posttraumatic rigid equinus with at least 1 year of follow-up after frame removal. The procedure consisted of percutaneous Achilles lengthening, gradual equinus correction using a multiplanar ring fixator, and AAA retaining the fixator in compression with screw augmentation. Frame removal depended on signs of union on the computed tomography scan. Visual analog scale (VAS) and Foot Function Index (FFI) scores were assessed as well as preoperative and postoperative x-rays. Complications were noted throughout the follow-up period. Five patients were treated with a mean age of 35 years and mean follow-up of 31 months. Deformities were gradually corrected into a plantigrade foot over an average duration of 6 weeks. Union was achieved in all patients with a mean time of an additional 25 weeks, for a mean total frame time of 31 weeks. The mean preoperative tibiotalar angle was 151 degrees and was corrected to 115 degrees. FFI score improved from a mean of 87 to 24 and VAS from 8 to 2. Posttraumatic rigid equinus can be treated effectively using gradual correction followed by integrated AAA in a safe and reproducible manner. Patients in this series had excellent functional, radiological, and satisfaction results. Level IV, retrospective case series.

Evaluation of Distraction Osteogenesis by Ilizarov Ring Fixator for Hypertrophic Nonunion of Tibia with Shortening and Deformity

Background: Hypertrophic nonunion often develops due to improper fracture immobilization or failed internal fixation. Gross mobility at the fracture site interferes with the normal healing process with the formation of fibrocartilage, which fails to mature into solid callus. Aim of the study: The aim of this study was to evaluate distraction osteogenesis by ilizarov ring fixator for hypertrophic nonunion of tibia with deformity and shortening. Methods: This was a quasi-experimental study conducted at National Institute of Traumatology &amp; Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh in the period from June 2011 to December 2012. Study population were all the patients with hypertrophic nonunion of tibia with shortening and deformity, attending out-patient department in NITOR. A total of 10 patients were included for evaluation from which 8 patients were selected using purposive sampling method. Surgery was with detailed preoperative x-ray analysis and measurement of magnitude of deformity and LLD. Other necessary investigations were done if clinically indicated and to prepare the patient for anesthesia. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The mean age of patients was 32.62 years and the lowest and the highest ages were 14and 55 years respectively. Type of deformity out of 08 patients, 07 patients had only angulation deformity and 01 had angulation translation deformity. Distribution of patients with the Plane of deformity reflects that 2 patients had sagittal plane and 6 had oblique plane. Conclusion: As the outcome evaluation was done 5-11 months after operation, changes in outcome beyond 3-11 months like Knee, ankle arthritis and symptom status, recurrence of deformity, collapse of lengthen segment could not be ascertained.

The role of anterior supra-acetabular external fixator as definitive treatment for anterior ring fixation in unstable pelvic fractures.

Management of anterior ring injuries is still a matter of discussion, and there are only few studies reporting anterior external fixator as definitive treatment for unstable pelvic injuries. This study aimed to describe the clinical and radiological outcomes of a consecutive series of mechanically unstable pelvic injuries that were treated with definitive anterior supra-acetabular external fixator for the anterior ring, and to identify risk factors for failure. We included a consecutive series of patients with unstable pelvic ring fractures who underwent anterior supra-acetabular external fixation for definitive treatment, between January 2012 and January 2020. All demographics, associated injuries and procedures, injury mechanism, and complications were analysed. Pelvic fracture was classified based on Orthopaedic Trauma Association/Tile AO (OTA/AO) and Young-Burgess classifications. Complications associated with the external fixator were revised. All patients were functionally evaluated at final follow-up and asked to report their clinical outcomes using the Majeed score. A total of 47 patients were included, of which 25 were females. The median age was 44years (interquartile range 23-59). Median follow-up duration was 14months (interquartile range 6-31). The most frequent aetiology was motor vehicle accident (35), followed by fall from height (8). All fractures required posterior pelvic ring fixation. The median time during which patients had external fixation in situ was 11weeks (interquartile range 9-13). All patients achieved healing of pelvic fracture at median time of 10weeks (interquartile range 8-12). At final follow-up, the median displacement of the anterior pelvis was 6mm (interquartile range 0-11). Superficial infection was the most common complication (n = 7). No washout procedures were needed. No major complication was reported. No patient required reoperation for anterior ring fracture. The median Majeed score was 88 points (range 60-95; interquartile range 80-90) at final follow-up. Our findings suggest that the use of supra-acetabular external fixator is safe and effective for definitive treatment of the anterior ring in unstable pelvic fractures. It is a method with high proportion of excellent results, regardless of the type of fracture. The rate of complications is low, and it does not compromise functional results.