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The Elevator Fragment Technique of Ilizarov in the Tibial Bone Nonunion with Bone Loss
Hamza Benameur, Marwane Abouchane, Mohamed Fahsi, Mostafa Fadili, Mohamed Nechad
Open Access Library Journal (OALib Journal) , 2015, DOI: 10.4236/oalib.1102063
Abstract: The management of nonunions with significant loss of bone remains a very difficult challenge for orthopedic surgeons. Several techniques have been developed, for some with difficult realization, and without convincing result for others. Our study involved two patients between 2012 and 2015, whom developed a tibial bone nonunion with significant loss of bone and having benefited from the elevator fragment technique using the Ilizarov external fixator. The evolution was good with filling of the bone loss and consolidation of the proximal osteotomy and the tibial nonunion with normal-oriented tibia. The filling of big post-traumatic bone losses by bone segmental transport, initially proposed by Ilizarov, finds its place in the reconstruction of the members, especially the tibia. This method is superior to other reconstruction techniques, in preserving the bone structure and equalizing its length. This technique has been adapted to be better tolerated by patients and more accessible to surgical teams, specifically the optimization of unilateral fixators for bone transport.
Lenthening of Tibia in CPT by Ilizarov’s Method
R. K Arora, Aarti Dewan
JK Science : Journal of Medical Education & Research , 2009,
Abstract: A case of Congenital Pseudarthrosis of Tibia (CPT) with 24 centimetres shortening in a young boy ofeighteen years treated by Ilizarov’s method is presented. No features of neurofibromatosis like café-aulaitspots or skin nodules were seen. Excision of Pseudarthrosis site, deformity correction and the lengtheningwas done by Ilizarov’s apparatus, through upper tibial metaphysis. The follow up of two years showedsound union. It gives credence to Ilizarov’s as being one of the best methods for treatment of CPT andlarge shortening.
Fibular lengthening by Ilizarov method secondary to shortening by osteochondroma of distal tibia
A. J. Johnston,C. T. Andrews
Strategies in Trauma and Limb Reconstruction , 2008, DOI: 10.1007/s11751-007-0028-2
Abstract: Osteochondroma is the most common benign bone tumour. They most commonly affect the long tubular bones and almost half of osteochondromata are found around the knee. Osteochondroma arising from the distal metaphysis of the tibia typically result in a valgus deformity of the ankle joint secondary to relative shortening of the fibula. This case describes the use of Ilizarov technique for fibular lengthening following excision of a distal tibial osteochondroma. A 12-year-old girl presented with a 3-year history of a large swelling affecting the lateral aspect of the right distal tibia. Plain radiographs confirmed a large sessile osteochondroma arising from the postero-lateral aspect of the distal tibia with deformity of the fibula and 15 mm of fibular shortening. The patient underwent excision through a postero-lateral approach and subsequent fibular lengthening by Ilizarov technique. The patient made excellent recovery with removal of frame after 21 weeks and had made a full recovery with normal ankle function by 6 months. The Ilizarov method is a commonly accepted method of performing distraction osteogenesis for limb inequalities; however, this is mainly for the tibia, femur and humerus. We are unaware of any previous cases using the Ilizarov method for fibular lengthening. This case demonstrates the success of the Ilizarov method in restoring both fibular length and normal ankle anatomy.
Treatment of septic pseudoarthrosis of tibia by Ilizarov method: Case report  [PDF]
Jovanovi? Vesna,Vuka?inovi? Zoran,?e?lija Igor,?ivkovi? Zorica
Srpski Arhiv za Celokupno Lekarstvo , 2010, DOI: 10.2298/sarh1010643j
Abstract: Introduction. Septic pseudoarthroses of the tibia represent a relatively frequent complication of open fractures with a large soft tissue damage. They may be localized: in the proximal metaphysis, between the proximal and middle thirds, between middle and distal thirds, in the distal metaphysis. Case Outline. A case of a 52-year-old man with open fracture of the left tibia is presented. He fell from the height of 30 meters. The external fixation according to Mitkovic was performed in another institution. The patient was referred to our hospital nine months after the accident, with clear clinical and radiological signs of septic pseudoarthrosis of the tibia. The resection of septic pseudoarthrosis was done two weeks after admission. Three weeks later, another operation was performed, bilocal alternating distractive-compressive osteosynthesis according to Ilizarov. After eleven months Ilizarov frame was removed, with clinical, radiological signs of healing of pseudoarthrosis and complete curing of the infection. Five months after removal of the frame, the patient was fully anatomically and functionally recovered. Conclusion. Being satisfied with the achieved results and encouraged with the data from the literature, we recommend this method as the method of choice for the treatment of pseudoarthrosis of the tibia. The advantage consists of curing the infection using the natural bactericide power of the tissue and curing the bone defect, at the same time, and finally, producing the equalization of the legs.
Prognosis of Open Type 3-B Tibia Fractures By Ilizarov Technique: A Prospective Study  [PDF]
Janak Rathod, Taral Shah
National Journal of Community Medicine , 2012,
Abstract: Background: Open fractures of the tibial shaft are both common and may be fraught with complications. Open fractures of the tibia, with associated vascular injuries, have historically had a very poor outcome. Malunion, delayed union, nonunion, and infection are all seen regularly after open tibia fractures. Objectives: Objective of the study is to explore advantage of primary or early ilizarov surgery in Open type 3- B fracture tibia. Methodology: A follow up study of 10 cases of open type 3-B tibia fractures between 20 to 60 years of age treated with primary or early ilizarov surgery in SMIMER Hospital, Surat. Results: Among 10 patients, 9 patients showed union between 8 to 10 months. Two patients developed pin track infection which was managed with oral antibiotics and daily pin tract dressings. One patient developed disuse calf muscle atrophy and 2 patient developed equines deformity in ankle joint due to soft tissue contracture. Conclusion: Ilizarov surgery in open type 3-B tibia fracture having higher union rate with less chance of infection and obscure amputation of limb though it is technically demanding and time consuming procedure.
Usefulness of Ilizarov's Procedure in Infected Non-Union of Tibia and Femur
R.K.Arora
JK Science : Journal of Medical Education & Research , 2003,
Abstract: A total of 46 patients with infected diaphyseal non-union of tibia (38) and femur (8) were subjected toIlizarov's ring fixator. Thirty six cases were of infected nonunion with gap requiring bone transp0l1(Group I) while 10 cases did not require bone tranasp0l1 (GroupII). In majority of group I casesunifocal corticotomies were done through metaphyses of the bone. In two cases, where the gap waslarge, bifocal corticotomies were done in tibia to shorten the treatment time. Controlled distraction wasbegun after 7 day's time. Normotrophic regenerate was observed in all cases except one case of tibiaand one femur. Both these cases required cancellous bone grafting. In group II, six cases of infectednon-union of tibia and four of infected femur required only radical debridement and acute compressionat the fracture site. Failure of union was seen only in two cases. I'orty four patients showed unionclinically and radiologically with a success rate of 95.4%.Equinus contracture (mild) and toe drop wereseen in one case of group I. Average follow up is of 67 months. Average distraction at corticotomy sitewas 60 mm. Average time for fixator removal was 239 days.
Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia
Elias S Vasiliadis, Theodoros B Grivas, Spyridon A Psarakis, Evangelos Papavasileiou, Angelos Kaspiris, Georgios Triantafyllopoulos
Journal of Orthopaedic Surgery and Research , 2009, DOI: 10.1186/1749-799x-4-35
Abstract: Thirty two patients with intra-articular fractures of the distal tibia have been studied. Based on the mechanism of injury they were divided into two groups. Group I includes 17 fractures due to axial compression and group II 15 fractures due to torsional force. An Ilizarov external fixation was used in 15 patients (11 of group I and 4 of group II). In 17 cases (6 of group I and 11 of group II) a unilateral hinged external fixator was used. In 7 out of 17 fractures of group I an additional fixation of the fibula was performed.All fractures were healed. The mean time of removal of the external fixator was 11 weeks for group I and 10 weeks for group II. In group I, 5 patients had radiological osteoarthritic lesions (grade III and IV) but only 2 were symptomatic. Delayed union occurred in 3 patients of group I with fixed fibula. Other complications included one patient of group II with subluxation of the ankle joint after removal of the hinged external fixator, in 2 patients reduction found to be insufficient during the postoperative follow up and were revised and 6 patients had a residual pain. The range of ankle joint motion was larger in group II.Intra-articular fractures of the distal tibia due to axial compression are usually complicated with cartilaginous problems and are requiring anatomical reduction of the articular surface. Fractures due to torsional forces are complicated with ankle instability and reduction should be augmented with ligament repair, in order to restore normal movement of talus against the mortise. Both Ilizarov and hinged external fixators are unable to restore ligamentous stability. External fixation is recommended only for fractures of the ankle joint caused by axial compression because it is biomechanically superior and has a lower complication rate.Treatment of intra-articular fractures of the distal tibia is challenging due to the difficulties they present in achieving anatomical reduction of the articular surface of the ankle joint and
Ilizarov methodology for infected non union of the Tibia: Classic circular transfixion wire assembly vs. hybrid assembly  [cached]
Baruah Ranjit
Indian Journal of Orthopaedics , 2007,
Abstract: Introduction: Conventional wire fixation of Ilizarov rings often fails to provide 90-90 configuration because of vital structures, which is essential for optimum stability. Hybrid assembly with half pins is an alternative. The aim of this study is to compare the results of Hybrid assembly with that of conventional classic circular transfixion wire Ilizarov assembly in 50 cases of infected nonunion of tibia between 1994 and 2003. Materials and Methods: This study includes two groups with 25 patients in each group: Group (A) conventional Ilizarov assembly and Group (B) hybrid Ilizarov assembly. Thirty-five cases developed infected nonunion following road traffic accidents while others after fall (6) bullet injury (4), infected osteosynthesis (3) and assault (2). There were 45 males and five females with mean age (18 to 56 years). All active cases (n=28) were treated by debridement including removal of implants in infected osteosynthesis. Twenty out of 22 cases in the quiescent group (non draining for last three consecutive months) were treated without open debridement; only two cases required open debridement for various reasons. All the cases were finally treated as atrophic aseptic nonunion with bone defect and were classified according to ASAMI. Type B1: length of the limb maintained with bone gap (14 cases in both Group A and B) and Type B3: combined shortening with defect (five and seven cases in Group A and B respectively), were treated by bifocal osteosynthesis. Only one case in the B3 group was treated by trifocal osteosynthesis to shorten the time. Type B2: segments in contact with limb shortening (total nine cases; five and four cases in Group A and B respectively) with shortening up to 2 cm (total five cases) were treated with monofocal osteosynthesis while shortening up to 5 cm and beyond (total four cases) were treated with bifocal osteosynthesis. Results: The cases were followed up for two to six years and the results were evaluated by Paley criteria of bony results ( union, infection, deformity and leg-length discrepancy ) and Functional Results (significant limp , equinus rigidity of the ankle, soft-tissue dystrophy, pain and inactivity) . In both the groups, 24 cases out of 25, had excellent to good bony result with Group B having twice more excellent result than Group A. Functional results were found to be similar in both the groups. Although persistence of infection and Grade III pin tract infection (PTI) were slightly higher in Group B, complications like delayed consolidation of regenerate, refracture, deformity and aneurysm of vessel
AMPUTATION OF THE TIBIA. LENGTH OF THE STUMP AND REHABILITATION DURATION UNDER THE WAR CONDITIONS
Slavica Jandric,Brano Topic
Acta Medica Medianae , 2001,
Abstract: The aim of the paper was to explore the functional correlation of, on one hand,the treatment and rehabilitation duration, and, on the other hand, the length of theamputation stump in the persons with the tibia amputation after explosion or shootingwounds. The cause was obtained by the random choice method from the protocols ofthe hospitalized patients. The average stump length was 19,22±3,36 cm. The correlationmethod gave very low values of the Pearson correlation coefficient (r=0,025).Such a result shows that there is no correlation between the stump length and therehabilitation duration (to the prosthesis phase). We can conclude that the stumplength in our sample is optimal for the prosthesis and that it has not considerablyaffected the rehabilitation duration when dealing with the war injuries of this type.
Treatment of gigantocellular tumor of the tibia metaphysis by means of the Ilizarov method: A case study  [PDF]
Tomi? Slavko,Le?i? Aleksandar,Bumba?irevi? V.,Kraj?inovi? O.
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0502131t
Abstract: The authors show a 36-year old female patient with a gigantocellular tumor of the distal metaphysis of the left tibia (stage III by Campanacci). A 7.6 cm long distal articular defect of the tibia has been formed by radical segmentary resection. The defect was compensated by the extension of the rest of the tibia; whereas the support function of the limb was provided through tibio-talar arthrodesis. 5.5 years after the surgery, there are no signs of local relapses; the patient walks without any orthopedic aids and works at the same job as prior to the operation.
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