Supracondylar osteotomy with Ilizarov fixation for elbow deformities in adults.

Stable fixation after a corrective supracondylar osteotomy in adults is difficult because of the irregularity of the area of bony contact, displacement of the fragments, the predominance of cortical bone, and the need for early mobilisation. We have used the Ilizarov apparatus for fixation in 15 patients who were treated by complex osteotomies with displacement of fragments for cubitus varus or valgus. Most patients with cubitus varus required medial displacement with rotation of the distal fragment. Those with cubitus valgus required lateral shift of the distal fragment to reduce the medial prominence of the elbow that would otherwise result. All osteotomies united within the expected time without loss of correction, despite early mobilisation. Complications related to the fixation were few and had resolved at the long-term follow-up.

Tratamento das infecçöes ósseas pelo método de Ilizarov usando o transporte ósseo e/ou a osteossíntese monofocal / Treatment of osseous infections with the Ilizarov method using bone transport and/or monofocal osteosynthesis

Os autores estudaram 44 casos referentes a 43 pacientes portadores de infecçöes ósseas com várias etiologias, tratadas pelo método de Ilizarov, no período de maio de 1988 a fevereiro de 1995, no Hospital Universitário de Taubaté. A limpeza ampla da área infectada seguida de transporte ósseo foi praticada em 19(43,1 por cento) pacientes. A osteossíntese monofocal (compressäo ou compressäo seguida de traçäo de afastamento - distraction) sem limpeza do foco infeccioso foi utilizada em 25(56,8 por cento) pacientes. Em 9(36 por cento) pacientes que apresentavam imagens cavitárias ao RX simples fez-se a osteotomia oblíqua sobre o foco infeccioso, com posterior drenagem por compressäo. A antibioticoterapia foi utilizada em todos os pacientes submetidos ao transporte ósseo, após identificaçäo do agente microbiano pela cultura do material colhido no ato operatório. O seguimento dos 43 pacientes foi no mínimo de 1 ano e 8 meses e no máximo de 6 anos e 9 meses, com acompanhamento médio de 4 anos, 2 meses e 15 dias. Nos 19(43,1 por cento) pacientes em que o transporte ósseo foi usado ocorreram 11(57,9 por cento) consolidaçöes sem recidiva da infecçäo. A infecçäo permaneceu inativa em 13(68,4 por cento) pacientes. A consolidaçäo aconteceu em 14(73,7 por cento) pacientes; 8(42,1porcento) pacientes apresentaram resultados insatisfatórios. Nos 25(56,8 por cento) pacientes em que se utilizou a osteossíntese monofocal, 23(92 por cento) obtiveram consolidaçäo sem recidiva da infecçäo. A consolidaçäo ocorreu em 24(96 por cento), dos quais 1 (4 por cento) manteve a infecçäo ativa. Outro dos pacientes desse grupo de estudo (4porcento) permaneceu em pseudoartrose infectada. Na avaliaçäo do total de 43 pacientes estudados, 37(77,3 por cento) obtiveram a consolidaçäo com foco infeccioso inativo até o presente momento, tendo sido considerado como bom resultado

Tratamento da pseudoartrose congênita da tíbia pelo método de Ilizarov: relato de caso / Treatment of congenital tibial pseudoarthrosis using Ilizarov's method: case report

Os autores apresentam o caso de um paciente do sexo masculino, com pseudartrose congênita e encurtamento importante da tíbia esquerda, após inümeros procedimentos cirúrgicos convencionais sem êxito, e seu resultado pelo método de Ilizarov.

Leg lengthening by the Ilizarov technique for patients with sequelae of poliomyelitis.

Limb length discrepancy is common in patients with sequelae of poliomyelitis. However, treatment of this problem is difficult and complicated. From 1988 to 1993, 71 patients with sequelae of poliomyelitis were treated with leg lengthening by modifications of the Ilizarov technique. Their median age at surgery was 26.4 years (range, 11.6-38.1 yr). Patients were divided into four groups according to the method of treatment, with femoral lengthening in 18 patients, combined femoral and tibial lengthening in 6, tibial lengthening in 35, and tibial lengthening along and intramedullary locking nail in 12. At follow-up of 2 to 6.7 years, the combined femoral/tibial group had the greatest gain in length. Treatment time in the Ilizarov device was shortest in the tibial lengthening with locking nail group. The lengthening index, which was defined as days in the Ilizarov device required for each centimeter of lengthening (days/cm), was lowest in the tibial lengthening with locking nail group, followed by the combined femoral/tibial lengthening group. Complications such as soft tissue contracture, callus fracture and residual deformities were most common in the combined femoral/tibial lengthening group and the femoral lengthening group. Complications were least common in the tibial lengthening with locking nail group. The satisfaction rate was highest in the tibial lengthening with locking nail group. We found that in leg lengthening for patients with sequelae of poliomyelitis, callus maturation was slow, and patients tended to develop contractures despite physiotherapy, bracing or joint fixation. Concomitant and secondary surgery were frequently required to treat associated problems or residual deformities. Lengthening along an intramedullary locking nail can significantly shorten the treatment time with relatively few complications.

Residual bone cysts after correction of severe foot deformities with the Ilizarov technique.

Fourteen patients with severe foot deformity treated by application of the Ilizarov device were evaluated for residual bone changes in the foot. Cyst formation was noted in all patients, most commonly in the base of the fifth metatarsal. These cysts did not develop in the area of bone penetrated by the wires. In an average follow-up of 3.4 years after device removal, the cysts did not resolve. Histologic examination of one resected cyst demonstrated an empty lacuna with no cell lining, as seen in the "cysts" associated with osteoarthrosis.

Extensimetric monitoring of healing in the treatment with the Ilizarov apparatus. A multicenter clinical trial.

The results of a multicentric review are reported using the extensimetric instrumentation applied to the Ilizarov device. This clinical trial the follows same theoretical and experimental preliminary studies, outlines the advantages and current limits of the method, and sets the bases for further clinical and experimental research.

Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator.

We treated 24 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Eleven fractures were open, and 20 patients had complex injuries. Twelve were treated by ligamentotaxis and percutaneous fixation, seven by limited open reduction and five by extensive open reduction. All were followed for at least 24 months. All the fractures united, with an average time to healing of 14.4 weeks. Thirteen patients achieved full extension and 13 more than 110 degrees of flexion. Twenty-two knees were stable. Fifteen patients walked normally and the rest with only a slight limp. All but two knees had an articular step-off of less than 4 mm and all had normal axial alignment except two. There were no cases of postoperative skin infection, osteomyelitis or septic arthritis. Ilizarov circular fixation is an ideal method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution.

Limb lengthening over an intramedullary nail. An animal study and clinical report.

With the goal of reducing the duration of external fixation in limb lengthening, the authors investigated the feasibility of limb lengthening over an intramedullary nail that could be statically locked when the desired length was achieved, permitting early removal of the external fixation device. In a preliminary study, 8 minigoats underwent 2.0-cm lengthening of the tibia by means of a uniplanar external fixator. Half of the goats had a reamed nail placed in the tibia at the initial surgery. By 10 weeks after lengthening, there no difference in radiographic, histologic, or biomechanical evidence of bone regeneration was found between the tibiae that were nailed and those that were not. In a following clinical series, 15 patients underwent tibial or femoral lengthening by means of a circular frame fixator with a reamed intramedullary nail in place. The postoperative course was uneventful except for 1 infection. The distraction gaps became ossified from 6 months to 1 year, and only 2 patients needed additional bone graftings. The joint function of the lengthened limb at last followup was good. Gradual limb lengthening with a reamed intramedullary nail in place is safe and effective and allows for early removal of the external fixation device.

Ilizarov treatment of pilon fractures.

The authors retrospectively reviewed 13 pilon fractures in 12 patients treated with a diaphyseal-epiphyseal technique of Ilizarov external fixation. Clinical followup averaged 16 months (range, 12-25 months). Eighty-four percent of the fractures had healed within 16 weeks after surgery. Average range of motion of the ankle was 12 degrees dorsiflexion and 25 degrees plantar flexion. One delayed union was treated with bone grafting and eventually healed; 1 nonunion was treated with ankle arthrodesis. Most patients (91%) experienced mild or no pain. There were no deep infections. This technique is an effective treatment option for tibial pilon fractures.

[The Ilizarov external fixator and method. Treatment of congenital and acquired deformities]. / Ilizarovs eksterne fiksasjonsapparat og metodikk. Behandling av medfødte og ervervede deformiteter.

The Ilizarov method, with external fixation by means of rings, rods and wires, has been used at the Norwegian National Hospital, Orthopaedic Centre, since 1992. The method is unique in correcting multiplanar deformities in one surgical procedure. We have treated 70 patients with a wide variety of orthopaedic etiologies. Soft tissue and bone deformities in the lower extremity have been corrected separately or combined. The frequency of complications has been relatively high, but we still think that the Ilizarov method is useful to correct complex deformities in children and adults alike.

Late reconstruction of patellar ligament ruptures using Ilizarov external fixation.

Chronic patellar ligament ruptures, on which failed reconstruction attempts have been made, cause structural changes in the quadriceps mechanisms with marked fixed proximal migration of the patella. Before reconstruction, the position of the patella must be normalized. When using Ilizarov principles and an Ilizarov external fixator to treat these ruptures, full weightbearing and range of motion can be maintained throughout the pre- and postreconstruction period. This previously unreported technique has been used in 2 patients with chronic patellar ligament ruptures in whom reconstruction attempts had failed. Successful results obtained with this procedure warrant its consideration for this rare but disabling problem.

Restoration of apposition function in residual hand by the Ilizarov method: a case report.

A five-year-old boy is presented with multiple finger and toe amputations, secondary to meningococcemia. The child developed a bimanual use pattern of the upper extremities with a significant amount of soft tissue scarring. The left hand was reconstructed according to Ilizarov's method by a combination of distraction lengthening of the metacarpals with two mini-Hoffman distractors and gradual interdigital space widening with web deepening accompanied by a modified Ilizarov apparatus. One year after removal of the external fixation frame, the web space is preserved and the child is adapting to the pincer-like function of his hands.

The Ilizarov technique in ankle fusion: a preliminary report.

Complex distal tibia fractures and failed ankle arthrodesis represent a significant challenge to today's orthopaedic surgeon. The complexity of these problems is further increased when associated with additional complications such as osteomyelitis, leg length discrepancy or concomitant foot deformity. In many instances, the only viable salvage alternative is amputation. The following is a preliminary report of nineteen cases of complex distal tibia pathology or failed ankle arthrodesis treated with the Ilizarov external fixator apparatus. Of the eighteen cases available for follow-up, fifteen (83.3%) achieved good results with solid ankle arthrodesis and resolution of associated pathology. The Ilizarov may be a viable clinical tool in these difficult cases where amputation is the alternative.

Use of Ilizarov distraction modified by Cattaneo and Catagni for femoral lengthening. / Zastosowanie dystraktora Ilizarova w modyfikacji Cattaneo i Catagniego do wydluzenia kosci udowej.

Ilizarov distraction device with proximal fixation by Cattaneo and Catagni has been used for femoral lengthening in 13 patients. Planned femoral elongation, fast remodeling of the newly formed bone and intended correction of the anatomical and mechanical axis of the limb have been achieved in all cases independently of the level of corticotomy. Full weight bearing was maintained during entire period of treatment.