Pelvic support osteotomy for unstable hips using hybrid external fixator: case series and review of literature.

BACKGROUND: Instability of the hip joint is a source of great discomfort to the patient due to pain, limp and leg-length discrepancy. Pelvic support osteotomy with Ilizarov hip reconstruction, along with its various modifications, has emerged as a standard treatment modality for this difficult problem. We present a series of patients with unstable hips treated with a modification of the monolateral fixator-the hybrid external fixator. MATERIALS AND METHODS: A retrospective review of a series of 23 patients (38 hips) with unstable hips treated at our institute with the hybrid external fixator was performed. The mean age of the patients was 19.1 years (range 7-49 years). The outcomes were evaluated radiologically and clinically using the Harris hip score. RESULTS: After a mean follow-up period of 30.5 months (range 10-91 months), the range of motion of the hip had improved, pain had decreased, and the Harris hip score had improved from 63.43 to 75.17, which was statistically significant. The pre-operative knee range of motion was achieved in all patients by the last follow-up. Trendelenburg gait disappeared in all patients except for 3, limb length discrepancy improved from a pre-operative mean of 43 mm to a post-operative mean of 5 mm at final follow-up, and the mechanical axis was regained in all patients. Pin-tract infections were the commonest complications, occurring in 12 patients (52%). CONCLUSIONS: This study shows that pelvic support osteotomy using the new hybrid external fixator, which combines the versatility and modularity of the Ilizarov frame with the compactness of the monolateral fixator, is a useful treatment modality in individuals with unstable hips.

Pitfalls of lengthening over an intramedullary nail in tibia: a consecutive case series.

BACKGROUND: Lengthening over a nail was introduced to reduce the overall complication rate in the classic Ilizarov method. Previous studies reported that an intramedullary nail could decrease the time of external fixation, prevent anatomic malalignment and collapse; Internal friction, damage to endosteal blood supply and infection rates, however, may be higher. Whether the approach achieves it goals with acceptable complication rates is unclear. The aim of this study was to describe the results and complications of tibial lengthening over a nail. METHODS: We retrospectively reviewed 40 patients with 80 lengthened tibial segments over an intramedullary nail between 2004 and 2009. The average age of the patients at the time of surgery was 22 years (range 18-38 years). Functional and psychological outcomes were evaluated using the questionnaires. RESULTS: The average lengthening achieved was 7.73 cm, 23.5% of initial length. The external fixation index was 1.1 months/cm, and bone-healing index was 1.7 month/cm. The most common complications were valgus angulations of tibia in 20 segments (25%) and equinus contracture in 58 segments (72%). Functional and psychological outcomes were satisfactory after surgery. CONCLUSIONS: Lengthening over a nail did not fully prevent axial deviation of regenerate. Equinus contracture was the most common complication but it could be rectified by early intervention such as intramuscular recession or an additional foot frame. Limb lengthening increased functional and psychological outcomes even though there were many complications after surgery.