Combined muscle flap and Ilizarov reconstruction for bone and soft tissue defects.

Thirty-six patients were treated by Ilizarov transport in conjunction with muscle and myocutaneous flaps coverage. Thirty-one free flaps and 5 rotation flaps were performed. In 13 patients the procedures were carried out in 1-stage or simultaneous manner. In 23 patients, soft tissue coverage proceeded as the initial step followed by Ilizarov reconstruction as a delayed procedure. All flaps survived the simultaneous and delayed procedures and there were no anastomotic complications, but partial flap necrosis occurred in 1 patient 3 months after the index procedure at the time of flap elevation for docking site bone graft placement. The mean segmental defects were 10 cm and 5.8 cm for the simultaneous and delayed groups, respectively. The followup interval from the time of free flap coverage ranged from 2 to 44 months in the simultaneous group with a mean and median of 22 and 24 months, respectively. Twelve patients completed treatment in the simultaneous group with the followup interval from frame removal ranging from 3 to 36 months with a mean and median of 18 and 14 months, respectively. In the delayed group this interval ranged from 1 to 36 months, with a mean and median of 16 and 12 months, respectively, and a mean and median of 24.5 and 21 months, respectively, from the time of the index procedure. Union and absence of infection were achieved in 35 of 36 patients presenting with an acute open fracture, infected nonunion, or aseptic nonunion without stable soft tissue coverage. The Ilizarov fixators remained in place for a median of 9.5 months for the simultaneous group and 8.5 months for the delayed group. When soft tissue defects accompany an infected nonunion or high grade open fracture, the traditional Ilizarov treatment approach of soft tissue recruitment into the wound from the distant corticotomy site is inconsistent with the proven benefit of early soft tissue coverage. The combined approach provides a more reliable soft tissue bed for early cancellous bone grafting of the docking site and permits the accurate restoration of limb length for these very difficult problems.

The widened teardrop distance: a plain film indicator of hip joint effusion in adults.

The teardrop distance is defined as the distance from the lateral margin of the pelvic teardrop to the most medial aspect of the femoral head as seen on anteroposterior pelvic radiographs. The structure responsible for the teardrop is the anteroinferior portion of the acetabular fossa with contributions from the ischium and from the superior pubic ramus. Anteroposterior pelvic radiographs of 10 patients with documented cases of unilateral hip effusion were retrospectively evaluated for teardrop distance widening on the affected side. Proof of the presence of hip effusion was based on the results of percutaneous hip joint aspirations as described in the patient's medical records. A teardrop distance widening of 1 mm or more was always consistent with hip joint fluid. In addition, radiographs from 20 patients with no known hip abnormalities were reviewed as a control population. These showed side-to-side symmetry in 16 cases (80%) and widening of less than 1 mm in the remaining four cases (20%). Thus, hip joint effusion in adults can be accurately diagnosed from plain radiographs in the presence of a teardrop asymmetry of 1 mm or more and in the absence of degenerative joint disease.

The effect of total knee arthroplasty prostheses design on the potential for salvage arthrodesis: measurements of volumes, lengths and trabecular bone contact areas.

Standardized plaster replicas of bony specimens were made to determine the mechanical and architectural requirements for arthrodesis subsequent to failed arthroplasty. Surprisingly small differences were noted in the total volume of bone removed from control compared with arthroplasty patients. There were correspondingly small differences in the bone and/or limb lengths. Limb length is not a consideration in selecting a prosthesis type. Varying with the type of prosthesis, there were wide differences in the contact area of trabecular bone remaining for fusion. Bulky femoral and tibial stems or protrusions are undesirable and greatly diminish the interface areas.