Ankle Arthrodesis Using the Ilizarov Technique in Difficult Situations - a Prospective Study with Mid-to Long-term Follow up.

BACKGROUND: Although various operative techniques are available for ankle arthrodesis, it is not rare to see orthopaedic surgeons facing difficult situations with ankles that cannot be reliably treated by any conventional methods other than the Ilizarov technique. This study was conducted to measure the outcome in such patients using the Ilizarov Ring fixator. MATERIAL AND METHODS: Sixteen patients (average age 47.5 years) had primary or revision unilateral ankle arthrodesis using the Ilizarov technique. Among the 16 patients the pathology included severe difficult posttraumatic arthritis with diabetes mellitus (n=7), failed arthrodesis with internal fixation (n=4), difficult post-septic arthritis (n=3) and 1 case each of rheumatoid arthritis and post-polio residual palsy with instability. The primary outcome was bony union and ankle alignment. The clinical results were further evaluated according to the American Orthopaedic Foot and Ankle Society scoring (AOFAS) System at 6 months and yearly till final follow-up. RESULTS: All ankles achieved arthrodesis at an average of 14 weeks (range 12-18 weeks). The average duration of follow-up was 5.7 years (range 4- 10 years). No major complication was seen except for 5 cases of superficial pin track infections, wound dehiscence in 1 patient and chronic discharging sinus in 1 patient. The average AOFAS score improved from an average of 35.25 (range 20- 44) points pre-operatively to an average of 78.37 (range 72-89) points at final follow-up. CONCLUSION: Ankle arthrodesis using Ilizarov technique shows a high fusion rate with no major complications and operative failures even in difficult and complicated situations.

Stable relocation of the radial head without annular ligament reconstruction using the Ilizarov technique to treat neglected Monteggia fracture: two case reports.

INTRODUCTION: A Monteggia facture dislocation is not an uncommon injury, and the diagnosis can often be missed. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, and loss of pronation and supination. Methods involving annular ligament reconstruction require post-operative immobilization and use of transcapitellar pinning for maintenance of reduction, and thus a delay in rehabilitation. The literature reports satisfactory results with methods that involve ulnar osteotomy and open reduction of the radial head without annular ligament reconstruction. We used the Ilizarov method in two cases with neglected Monteggia fracture dislocations to stably reduce the radial head without open reduction and annular ligament reconstruction. CASE PRESENTATION: We report two cases of neglected Monteggia fracture dislocation, in two Kashmiri boys aged four and six years. Using ulnar osteotomy with distraction osteogenesis, we were able to relocate the radial head gradually and maintain the reduction without a requirement for open reduction and annular ligament reconstruction. CONCLUSION: Distraction lengthening and hyperangulation in different planes by use of the Ilizarov technique effectively reduces the radial head without open reduction and annular ligament reconstruction.

Lateral invaginating peg (LIP) osteotomy for the correction of post-traumatic cubitus varus deformity.

Closing wedge osteotomies are the gold standard for the management of post-traumatic cubitus varus deformity. However, most of these osteotomies are fraught with complications such as lateral condylar prominence, instability, and difficulty in correcting internal rotation. We describe a new technique that provides a means for the management of all these problems simultaneously.

Complications of paediatric elbow trauma treatment by traditional bonesetters.

This is a retrospective review of paediatric elbow trauma, which was initially treated by bonesetters and subsequently reported to the hospital for management. This paper describes the pattern of trauma and the complications of unscientific management. The report also recommends a basic training program for the bonesetters so as to make them aware of the potential complications involved in managing paediatric elbow trauma.

Outcome of treatment of the mismanaged pediatric elbow trauma: a series of 73 cases.

PURPOSE: To analyze the outcome of the management of pediatric elbow trauma referred to our hospital after initial intervention by traditional bone setters. METHOD: Retrospective study of 73 patients, presenting to the hospital with a complication attributable to the initial mismanagement of their injuries. RESULTS: The mode of presentation was directly related to the type of initial intervention on the basis of which we were able to quantify bone setters into two groups. The first group using a rather rough method of trauma treatment involving the application of tight local bandages, massage and manipulation and a second group having a relatively less rough approach, applying splints to the injured extremity without tight bandages and manipulation. The result of treatment of these injuries was determined by the delay in presentation and the type of injury. CONCLUSION: This study highlights the importance of dealing with the unchecked and unsupervised practice of bone setting in the developing world. We believe that training these people on the pattern of traditional birth attendants can at the very least lower the occurrence, if not entirely eliminate the problem of mismanaged trauma in this part of the world.

Deformity correction and massive lengthening on a centralized fibula with the Ilizarov technique.

Lengthening beyond 25% of the original segment length is an orthopaedic challenge. Substantial lengthening is fraught with complications such as joint contractures, refractures, nerve injuries and prolonged periods of consolidation. We report a case of massive lengthening in a 17-year-old boy in whom a 20 cm lengthening (57% lengthening) and complex deformity correction was performed on a centralized fibula using the Ilizarov technique, with an excellent result. A total of 17 months were taken to complete the process of lengthening and consolidation at a healing index of 0.85 months/cm. Besides a minor pin tract infection, there were no major complications. We believe that with meticulous pre operative planning and follow-up the extent of lengthening can be extended in cases of severe limb length discrepancy.